CT-guided therapy means no sweat

Sweaty hands, or palmar hyperhidrosis, can hinder a person's social or professional life. A minimally invasive procedure performed under CT fluoroscopy guidance provides a permanent solution to the embarrassing problem, according to Belgian researchers.

Options available to cure palmar hyperhidrosis range from electricity to botox injections and surgery. The degree of each therapy's success and side effects varies. Results don't last long in many cases, and treatments may hurt both flesh and pocketbooks.

Percutaneous sympathectomy - injecting a drug that blocks the nerve terminals linked to overproducing sweat glands - can treat the condition as effectively as laparoscopy-guided sympathectomy. The CT fluoro-guided technique takes about 20 minutes, requires local anesthesia only, and poses minimal risk of complications.

Investigators presented their findings from these interventions at the 2005 RSNA meeting.

"This CT-guided percutaneous technique is the most secure treatment today. It stops sweating from the hands to the armpits with very little chance of recurrence," said principal investigator Dr. Hugues Brat, chief of radiology at Centre Hospitalier Hornu-Frameries in Belgium.

Brat and coauthor Dr. Tarik Bouziane treated 50 consecutive patients with palmar hyperhidrosis. Multislice CT fluoroscopy enabled accurate needle guidance. Forty-seven patients (94%) showed sweat interruption immediately after intervention, while three required a second, successful, procedure. There were no significant complications, though 16 patients experienced minor complications such as chest pain or discomfort.

Transthoracic or endoscopic sympathectomies were the only permanent treatments known previously for this condition affecting three out of 100 people in the U.S. Both procedures have a good record but can produce serious complications such as bleeding, atelectasis, Horner syndrome, and partial paralysis.

Percutaneous sympathectomy requires interventionalists to make a single needle puncture through the patient's upper back. CT fluoro guides the injection of a phenol-based drug that interrupts nerve tracts and nodes connected to the sweat glands. The procedure is less expensive than open or endoscopic surgery and is often covered by medical insurance.

"This is the most precise and effective treatment of palmar hyperhidrosis available," Brat said.

Results are permanent, and the procedure is not for everyone. Sweating should significantly impair a patient's life before intervention is considered. Patients must balance out possible cure with potential risks and side effects, Brat said.

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