Destruction of any nerve can be achieved with different methods. The first one that was tried with deactivation of the sympathetic chain was done with excision of the nerve or destruction of it with electrical / ultrasound thermal activity. Later on putting a clamp on the nerve became a favorite method used by many surgeons. Chemical ablation or destruction of a nerve was described as well. This particular method of CT guided chemical ablation requires an enthusiastic interventional radiologist to perform these procedures but as of yet there are not too many centers who are getting involved with this particular method. Even with CT guided techniques the accuracy of installing the chemical ablating material is not as effective as predicted. The injected material can seep away to adjacent tissues and usually the use of alcohol is relatively limited in terms of long term benefit. The other material that was used was Phenol which is very dangerous to be injected due to the extreme burn that can be caused to adjacent tissues.

The technical ability is there but not with good results. Another point which should be raised is the fact that once the chemical is injected into the nerve or in the vicinity of the nerve there is no control over how far that material will spread. The chemical which is used is made of highly concentrated alcohol. In certain countries phenol is allowed but in the US phenol is not allowed for use. The reason is that this chemical material can cause serious damage to surrounding tissues. There are a few reports describing severe damage to certain important structures when phenol was used.

As for thoracic sympathectomy the endoscopic approach became the most used method to deal with palmar hyperhidrosis. As for lumbar sympathectomy being a very challenging procedure attempts were made to find a less invasive procedure such as chemical lumbar sympathectomy. The same drawbacks mentioned previously with regard to accuracy as well as the uncontrolled of the chemical material proved to be true especially in chemical lumbar sympathectomy. Not only were the desired results not obtained but also serious side effects / complications occurred. If a patient failed chemical lumbar sympathectomy they a renewed attempt to do it surgically is an extremely challenging proposition due to the fact that chemical material can cause severe scarring in the retro peritoneal region making the procedure almost impossible to perform.

If a patient faces this option he/she should consider the above mentioned information and discuss it with the physician who offers this approach.

Recently some information came about the treatment of compensatory sweating by means of alcohol injection (chemical ablation) in cases of compensatory sweating. It was used in patients (a small number) that developed facial and scalp sweating after ETS. Generally speaking this is a rare side effect but in the cases described there was alleviation of this particular type of this side effect on a temporary basis. This was achieved by injection of alcohol with the CT guided method. We need more cases to be done with this method. As more information is obtained it will be available for the general public. So far from the known literature the use of alcohol injections on multiple levels of the sympathetic has not proved to be very efficient.

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