{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,23]],"date-time":"2026-05-23T09:09:15Z","timestamp":1779527355894,"version":"3.53.1"},"reference-count":42,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"2","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["FOC"],"published-print":{"date-parts":[[2008,8]]},"abstract":"<jats:p>Palmar hyperhidrosis is a disorder of the autonomic nervous system characterized by excessive perspiration of the palms, but may involve other body parts as well. Traditional posterior approaches have been performed less often in favor of less invasive thoracoscopic sympathectomies, which have a high success rate with low associated morbidity. However, some patients are not candidates for a transthoracic surgery and may need an alternative treatment strategy.<\/jats:p>\n                  <jats:p>In situations in which a posterior approach may be necessary, the authors have developed a minimal access endoscopic-assisted dorsal sympathectomy procedure, applying minimally invasive spine muscle splitting techniques. The authors believe that the development of this technique may help to minimize surgical morbidity associated with the traditional posterior approach by reducing pain, tissue damage, and length of postoperative recovery. This paper is a report on the successful treatment of palmar hyperhidrosis using a minimally invasive posterior technique and describes the surgical approach and outcomes in 2 patients who have been treated in this manner.<\/jats:p>\n                  <jats:p>Two patients underwent minimally invasive endoscopic-assisted posterior thoracic sympathectomy for hyperhidrosis. Both patients experienced relief of their symptoms after surgery with follow-up durations of 32 and 9 months and length of stays of 0.9 and 2.8 days, respectively. One patient suffered a unilateral Horner syndrome and underwent an eyelid lift. The other patient was readmitted to the hospital 2 days after discharge with atelectasis. She was obese and suffered from chronic obstructive pulmonary disease at baseline, which were reasons she opted for a posterior approach. Neither patient suffered a pneumo- or hemothorax.<\/jats:p>\n                  <jats:p>Minimally invasive endoscopic-assisted posterior thoracic sympathectomy can be safely performed for relief of hyperhidrosis. The procedure has risks for the usual complications of sympathectomy. This technique may provide an alternative to thoracoscopic approaches, especially in those patients with pulmonary disease or obesity.<\/jats:p>","DOI":"10.3171\/foc\/2008\/25\/8\/e6","type":"journal-article","created":{"date-parts":[[2008,8,1]],"date-time":"2008-08-01T13:41:46Z","timestamp":1217598106000},"page":"E6","source":"Crossref","is-referenced-by-count":5,"title":["Minimally invasive endoscopic-assisted posterior thoracic sympathectomy"],"prefix":"10.3171","volume":"25","author":[{"given":"Paul A.","family":"Gardner","sequence":"first","affiliation":[{"name":"Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pawel G.","family":"Ochalski","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John J.","family":"Moossy","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"key":"b1-0250006","series-title":"Ann Surg","first-page":"34","article-title":"Palmar hyperhidrosis and its surgical treatment: a report of 100 cases","volume":"186","author":"Adar","year":"1977"},{"key":"b2-0250006","series-title":"J Neurol Neurosurg Psychiatry","first-page":"277","article-title":"Excessive sweating: an uncommon sign of basilar artery occlusion","volume":"54","author":"Awada","year":"1991"},{"key":"b3-0250006","series-title":"Br J Surg","first-page":"45","article-title":"Intermediate-term results of endoscopic transaxillary T2 sympathectomy for primary palmar hyperhidrosis","volume":"86","author":"Chiou","year":"1999"},{"key":"b4-0250006","series-title":"J Neurosurg","first-page":"545","article-title":"Hyperhydrosis","volume":"30","author":"Cloward","year":"1969"},{"key":"b5-0250006","series-title":"Am J Clin Dermatol","first-page":"681","article-title":"Management of primary hyperhidrosis: a summary of the different treatment modalities","volume":"4","author":"Connolly","year":"2003"},{"key":"b6-0250006","series-title":"Neurosurgery","first-page":"306","article-title":"Biportal thoracoscopic sympathectomy: surgical techniques and clinical results for the treatment of hyperhidrosis","volume":"50","author":"Han","year":"2002"},{"issue":"Suppl 572","key":"b7-0250006","series-title":"Eur J Surg","first-page":"13","article-title":"Thoracoscopic versus open supraclavicular upper dorsal sympathectomy: a prospective randomised trial","author":"Hashmonai","year":"1994"},{"key":"b8-0250006","series-title":"Ann Surg","first-page":"86","article-title":"Endoscopic thoracic sympathectomy for primary hyperhidrosis of the upper limbs. A critical analysis and long-term results of 480 operations","volume":"220","author":"Herbst","year":"1994"},{"key":"b9-0250006","series-title":"Proc R Soc Med","first-page":"585","article-title":"Endoscopic sympathectomy","volume":"35","author":"Hughes","year":"1942"},{"key":"b10-0250006","series-title":"Rev Med Suisse Romande","first-page":"111","article-title":"R\u00e9section partielle du tronc sympathique cervical droit pour hyperhidrose unilat\u00e9rale (regions faciale, cervicale, thoracique et brachiale droites)","volume":"40","author":"Kotzareff","year":"1920"},{"key":"b11-0250006","series-title":"Dis Chest","first-page":"139","article-title":"The endoscopic approach to the vegetative nervous system and its therapeutic possibilities; especially in duodenal ulcer, angina pectoris, hypertension and diabetes","volume":"20","author":"Kux","year":"1951"},{"key":"b12-0250006","series-title":"Neurology","first-page":"1679","article-title":"Unilateral hyperhidrosis after cerebral infarction","volume":"38","author":"Labar","year":"1988"},{"key":"b13-0250006","series-title":"Surg Neurol","first-page":"453","article-title":"Transthoracic endoscopic sympathectomy in the treatment of palmar hyperhidrosis\u2014with emphasis on perioperative management (1,360 case analyses)","volume":"52","author":"Lin","year":"1999"},{"key":"b14-0250006","series-title":"Eur Respir J","first-page":"1660","article-title":"Thoracoscopic sympathicolysis for essential hyperhidrosis: effects on pulmonary function","volume":"9","author":"Noppen","year":"1996"},{"key":"b15-0250006","series-title":"AMA Arch Surg","first-page":"659","article-title":"Anterior transthoracic approach for upper thoracic sympathectomy","volume":"72","author":"Palumbo","year":"1956"},{"issue":"5 Suppl","key":"b16-0250006","series-title":"Neurosurgery","first-page":"S129","article-title":"Microendoscopic lumbar discectomy: technical note","volume":"51","author":"Perez-Cruet","year":"2002"},{"key":"b17-0250006","series-title":"Neurosurgical Operative Atlas","first-page":"267","article-title":"Upper thoracic sympathectomy by a posterior midline approach","author":"Pillay","year":"1991"},{"issue":"Suppl 580","key":"b18-0250006","series-title":"Eur J Surg","first-page":"23","article-title":"The Bor\u00e5s experience of endoscopic thoracic sympathicotomy for palmar, axillary, facial hyperhidrosis and facial blushing","author":"Rex","year":"1998"},{"issue":"4 Suppl","key":"b19-0250006","series-title":"Neurosurgery","first-page":"357","article-title":"Microendoscopic discectomy compared with standard microsurgical discectomy for treatment of uncontained or large contained disc herniations","volume":"57","author":"Schizas","year":"2005"},{"key":"b20-0250006","series-title":"J Auton Nerv Syst","first-page":"33","article-title":"Autonomic dysfunction in palmar hyperhidrosis","volume":"8","author":"Shih","year":"1983"},{"key":"b21-0250006","series-title":"Ann Thorac Surg","first-page":"1177","article-title":"Video assistance reduces complication rate of thoracoscopic sympathicotomy for hyperhidrosis","volume":"68","author":"Zacherl","year":"1999"},{"key":"b1-0250006","series-title":"Ann Surg","first-page":"34","article-title":"Palmar hyperhidrosis and its surgical treatment: a report of 100 cases","volume":"186","author":"Adar","year":"1977"},{"key":"b2-0250006","series-title":"J Neurol Neurosurg Psychiatry","first-page":"277","article-title":"Excessive sweating: an uncommon sign of basilar artery occlusion","volume":"54","author":"Awada","year":"1991"},{"key":"b3-0250006","series-title":"Br J Surg","first-page":"45","article-title":"Intermediate-term results of endoscopic transaxillary T2 sympathectomy for primary palmar hyperhidrosis","volume":"86","author":"Chiou","year":"1999"},{"key":"b4-0250006","series-title":"J Neurosurg","first-page":"545","article-title":"Hyperhydrosis","volume":"30","author":"Cloward","year":"1969"},{"key":"b5-0250006","series-title":"Am J Clin Dermatol","first-page":"681","article-title":"Management of primary hyperhidrosis: a summary of the different treatment modalities","volume":"4","author":"Connolly","year":"2003"},{"key":"b6-0250006","series-title":"Neurosurgery","first-page":"306","article-title":"Biportal thoracoscopic sympathectomy: surgical techniques and clinical results for the treatment of hyperhidrosis","volume":"50","author":"Han","year":"2002"},{"issue":"Suppl 572","key":"b7-0250006","series-title":"Eur J Surg","first-page":"13","article-title":"Thoracoscopic versus open supraclavicular upper dorsal sympathectomy: a prospective randomised trial","author":"Hashmonai","year":"1994"},{"key":"b8-0250006","series-title":"Ann Surg","first-page":"86","article-title":"Endoscopic thoracic sympathectomy for primary hyperhidrosis of the upper limbs. 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