Neurosurgical Procedures of the Sympathetic Nervous System

  • Harold Arthur Wilkinson


Sympathetically mediated or sympathetically dependent pain encompasses a spectrum of conditions that have in common the factor that the pain can be relieved, at least temporarily, through sympathetic interruption.1–11 The pain may be accompanied by, or may be caused by, dystrophic changes or impaired circulation, but can occur without these physical concomitants and often is accompanied by considerable psychological distress. Sympathetically mediated pain most commonly affects the extremities or causes a specific type of cardiac pain. Diagnostic sympathetic blocks are important not only to determine when pain is sympathetically mediated, but also because one or more sympathetic blocks may provide permanent pain relief. Unfortunately, temporary relief from sympathetic diagnostic blocks does not guarantee permanent relief of the sympathetically mediated pain by sympathectomy, and the sympathectomy may fail to reverse the associated vascular or dystrophic changes. Sympathetically mediated pain states are not uncommon, but are frequently difficult to diagnose or to diagnose with certainty, and their management frequently challenges the skill and perseverance of the clinician.


Sympathetic Nervous System Brachial Plexus Sympathetic Ganglion Reflex Sympathetic Dystrophy Stellate Ganglion 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Ascherl R, Blumel G. Zum krankheitsbild der Sudek’schen dystrophie. Fortschr Med. 1981;99: 712–720.PubMedGoogle Scholar
  2. 2.
    Dawson DM, Katz M. Reflex sympathetic dystrophy. Neurol Chron. 1993;2:1–6.Google Scholar
  3. 3.
    Gybels JM, Sweet WH. Sympathectomy for pain. In: Neurosurgical Treatment of Persistent Pain. New York: Karger; 1984:257–282.Google Scholar
  4. 4.
    Hardy RW Jr. Surgery of the sympathetic nervous system. In: Schmidek HH, Sweet WH, eds. Operative Neurosurgical Techniques: Indications, Methods and Results. 1982;2:1045–1061.Google Scholar
  5. 5.
    Leriche R. De la traitement de la douleur dans les cancers abdominaux et pelvieus inoperables ou recidives. Gaz Hopit Civils Milit. 1936;109:917–922.Google Scholar
  6. 6.
    Mayfield FH. Causalgia. Springfield, Ill: Charles C. Thomas; 1951.Google Scholar
  7. 7.
    Mitchell SW. Injuries of Nerves and Their Consequences. Philadelphia: JB Lippincott; 1872.Google Scholar
  8. 8.
    Ockoa J. Afferent and sympathetic roles in chronic “neuropathic” pains: confessions on misconceptions. In: Besseon JM, Guilband G, eds. Lesions of Primary Afferent Fibers as a Tool for the Study of Clinical Pain. New York: Elsevier; 1991.Google Scholar
  9. 9.
    Schwartzman RJ, McLellan TL. Reflex sympathetic dystrophy: a review. Arch Neurol. 1987;44: 555–561.PubMedCrossRefGoogle Scholar
  10. 10.
    Sweet WH. Sympathectomy for pain. In: Youmans JR, ed. Neurological Surgery. 3rd ed. Philadelphia: WB Saunders; 1990:4086–4107.Google Scholar
  11. 11.
    Ulmer JL, Mayfield FH. Causalgia: a study of 75 cases. Surg Gynecol Obstet. 1946;83:789–795.PubMedGoogle Scholar
  12. 12.
    Raja SN, Treed R, Davis KD, Campbell JN. Systemic alpha-adrenergic blockade with phentolamine: a diagnostic test for sympathetically maintained pain. Anesthesiology. 1991;74:691–698.PubMedCrossRefGoogle Scholar
  13. 13.
    Lofstrom JB, Cousins MJ. Sympathetic neural blockade of upper and lower extremity. In: Cousins MJ, Bridenbaugh PO, eds. Neural Blockade in Clinical Anesthesia and Management of Pain. 2nd ed. Philadelphia: JP Lippincott; 1988:461–500.Google Scholar
  14. 14.
    Gjerris F, Olesen HP. Palmar hyperhidrosis: longterm results following high thoracic sympathectomy. Acta Neurol Scand. 1975;51:167–172.PubMedCrossRefGoogle Scholar
  15. 15.
    Mattassi R, Miele F, D’Angelo F. Thoracic sympathectomy: review of indications, results and surgical techniques. J Cardiovasc Surg. 1981;22:336–339.Google Scholar
  16. 16.
    Howng S-L, Loh J-K. Long term follow-up of upper dorsal sympathetic ganglionectomy for palmar hyperhidrosis-a scale of evaluation. Kaohsiung J Med Sci. 1987;3:703–707.Google Scholar
  17. 17.
    White JC, Smithwick RH. The Autonomic Nervous System: Anatomy, Physiology and Surgical Application. 2nd ed. New York: Macmillan; 1941.Google Scholar
  18. 18.
    White JC, Sweet WH. Pain: Its Mechanisms and Neurosurgical Control. Springfield, Ill: Charles C. Thomas; 1955.Google Scholar
  19. 19.
    Telford ED. The technique of sympathectomy. Br J Surg. 1935;23:440–480.CrossRefGoogle Scholar
  20. 20.
    Atkins HJB. Sympathectomy by the axillary approach. Lancet. 1954;1:538–539.CrossRefGoogle Scholar
  21. 21.
    Berguer R, Smit R. Transaxillary sympathectomy (T2 to T4) for relief of vasospastic/sympathetic pain of upper extremities. Surgery. 1981;89: 764–769.PubMedGoogle Scholar
  22. 22.
    Campbell WB, Cooper MJ, et al. Transaxillary sympathectomy: is a one-stage bilateral procedure safe? Br J Surg. 1982;69(suppl):S29.PubMedCrossRefGoogle Scholar
  23. 23.
    Jochimsen PR, Hartfall WG. Peraxillary upper extremity sympathectomy: technique reviewed and clinical experience. Surgery. 1972;7:686.Google Scholar
  24. 24.
    Linder F, Jenal G. Assmus H. Axillary transpleural sympathectomy: indication, technique and results. World J Surg. 1983;7:437.PubMedCrossRefGoogle Scholar
  25. 25.
    Kempe L. Operative Neurosurgery. New York: Springer-Verlag; 1970;2:240–243.Google Scholar
  26. 26.
    Little JM, May J. A comparison of the supraclavicular and axillary approaches to upper thoracic sympathectomy. Aust NZ J Surg. 1975;45:143.CrossRefGoogle Scholar
  27. 27.
    Kux E. Thorakoskopische Eingriffe am Nervensystem. Stuttgart: Georg Thieme; 1954.Google Scholar
  28. 28.
    Kux M. Thoracic endoscopic sympathectomy by transthoracic electrocoagulation. Br J Surg. 1980; 67:71.CrossRefGoogle Scholar
  29. 29.
    Malone PS, Dingnan JP, Hederman WP. Transthoracic electrocoagulation (T.T.E.C.)-a new and simple approach to upper limb sympathectomy. Irish Med J. 1982;75:20–21.Google Scholar
  30. 30.
    Rosner K. Goldbertg S. Der stellenwert der thorakoskopischen sympathectomie bei der behandlung des Raynaud-syndrome. Z Gesamte Inn Med. 1979;34:127–128.PubMedGoogle Scholar
  31. 31.
    Weale FE. Upper thoracic sympathectomy for transthoracic electrocoagulation. Br J Surg. 1980; 67:71–72.PubMedCrossRefGoogle Scholar
  32. 32.
    Wilkinson HA. Percutaneous radiofrequency upper thoracic sympathectomy: a new technique. Neurosurgery. 1984;15:811–814.PubMedCrossRefGoogle Scholar
  33. 33.
    Wilkinson HA. Radiofrequency percutaneous upper thoracic sympathectomy: technique and review of indications. N Eng J Med. 1984;311:34–36.CrossRefGoogle Scholar
  34. 34.
    Wilkinson HA. Percutaneous radiofrequency upper thoracic sympathectomy. Neurosurgery. 1996; 38:715–725.PubMedCrossRefGoogle Scholar
  35. 35.
    Pemak JM, Berg HVD. Treatment of chronic low back pain following lumbar disc operations by using thermolesion of sympathetic ganglion. In: Erdmann, et al, eds. The Pain Clinic I. VNU Science Press; 1985:177–186.Google Scholar
  36. 36.
    Cross FW, Cotton LT. Chemical lumbar sympathectomy for ischemic rest pain. A randomized, prospective controlled clinical trial. Am J Surg. 1985;150:341–345.CrossRefGoogle Scholar
  37. 37.
    Haxton HA. Chemical sympathectomy. Br Med J. 1949;1:1026–1028.PubMedCrossRefGoogle Scholar
  38. 38.
    Ogawa S. Sympathectomy with neurolytics. In: Hyodo M, Oyama T, Swerdlow M, eds. The Pain Clinic IV. Utrecht: VSP Publishers; 1992: 139–146.Google Scholar
  39. 39.
    Reid W, Watt JK, Gray TG. Phenol injection of the sympathetic chain. Br J Surg. 1970;57: 45–50.PubMedCrossRefGoogle Scholar
  40. 40.
    Scott DB, Littlewood DG. Chemical lumbar sympathectomy with radiological assessment. Ann R Coll Surg Engl. 1982;64:135.Google Scholar
  41. 41.
    Leriche R, Fontaine R. Chirurgie des nerfs du coeur. J Chir (Paris). 1932;40:508–525.Google Scholar
  42. 42.
    Montorsi W, Chringhelli C, Amoni F. Indications and results of the surgical treatment of Raynaud’s phenomenon. J Cardiovasc Surg. 1980;21: 203–210.Google Scholar
  43. 43.
    Dos SJ. Cardiac sympathectomy for angina pectoris. Ann Thorac Surg. 1978;25:178–179.PubMedCrossRefGoogle Scholar
  44. 44.
    Henrard L, Pierrard L, Limet R. Traitment par sympathectomie thoracique de l’angor de Prinzmetal a coronaires saines. Arch Mal Coeur. 1982;75: 1317–1319.PubMedGoogle Scholar
  45. 45.
    Spodick DH. Partial sympathetic denervation for variant angina pectoris. Am J Cardiol. 1983; 52:1153.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 1997

Authors and Affiliations

  • Harold Arthur Wilkinson

There are no affiliations available

Personalised recommendations