The amount of compensatory sweating depends on the patient, the damage that the white rami communicans incurs, and the amount of cell body reorganization in the spinal cord after surgery.
Other potential complications include inadequate resection of the ganglia, gustatory sweating, pneumothorax, cardiac dysfunction, post-operative pain, and finally Horner’s syndrome secondary to resection of the stellate ganglion.
www.ubcmj.com/pdf/ubcmj_2_1_2010_24-29.pdf

After severing the cervical sympathetic trunk, the cells of the cervical sympathetic ganglion undergo transneuronic degeneration
After severing the sympathetic trunk, the cells of its origin undergo complete disintegration within a year.

http://onlinelibrary.wiley.com/doi/10.1111/j.1439-0442.1967.tb00255.x/abstract

Friday, January 2, 2009

Drawbacks of sympathectomy

Radiofrequency neurolysis (RFN) is becoming a popular method of sympathectomy among pain specialists. The advantages of RFN over chemical and surgical sympathectomy are decrease incidence of neuritis, avoidance of tinitus, blindness and urethral stricture that can occur with chemical sympathectomy, amelioration of anesthetic and surgical risks and early ambulation of the patient. The reasons for the failure of sympathectomy are incomplete sympathectomy, extensive interconnection of chains of sympathectomy ganglia cause rerouting of sympathetic impulse after removal of short chain of ganglia, and hypersensitization of adenoreceptors in the sympathectomized area.

Meraj Siddiqui, Shazia Siddiqui, J. Sue Ranasinghe & Fred Furgang: Complex Regional Pain Syndrome: A Clinical Review: Pain, Symptom Control and Palliative Care. 2001; Volume 2, Number 1.

http://www.ispub.com/ostia/index.php?xmlPrinter=true&xmlFilePath=journals/ijpsp/vol2n1/cps.xml

cardiovascular adjustment to exercise and sympathectomy

Mean arterial pressure and total peripheral resistance were significantly reduced at rest and during steady state of exercise as compared to controls prior to sympathectomy identical vO2, whereas CO remained unchanged.
The significant fall in left circumflex coronary flow was proportional to the decline in external heart work due to sympathectomy both at rest and under exercise.

http://www.springerlink.com/content/k2n6j4555g16x773/

Coronary blood flow reduced by 50% after sympathectomy

However, at each level of exercise, mean coronary flow in sympathectomized ventricles was reduced by about 50% compared to control values. The slopes of coronary flow on pressure-rate product and tension-time index were also reduced. No difference in left ventricular oxygen extraction between control and sympathectomized hearts were observed. Thus, chronic ventricular sympathectomy altered the relationships between coronary flow and oxygen consumption, on the one hand, and ventricular oxygen-dependent performance and whole-body exercise level, on the other hand.
Med Sci Sports Exerc. 1988 Apr;20(2):126-35.
http://www.ncbi.nlm.nih.gov/pubmed/3367747

Sympathectomy impaired the PTH (parathyroid hormone) response to hypocalcaemia

Clinical Physiology and Functional Imaging

Volume 10 Issue 1, Pages 37 - 53Published Online: 28 Jun 2008

surgical sympathectomy is known to induce resorption within mandibular and auditory bulla bone

Bone destruction causes hearing loss in various middle ear disorders. The mechanisms of such pathological remodeling are unknown.
Unilateral surgical sympathectomy is known to induce resorption within mandibular and auditory bulla bone. Explanation of the cause of this effect, however, may be confounded by hemodynamic changes induced by hemicranial sympathectomy and by uncertainty as to the neuroanatomical origins of sympathetic fibers.
Ann Otol Rhinol Laryngol. 1999 Nov;108(11 Pt 1):1078-87.
http://www.ncbi.nlm.nih.gov/pubmed/10579236

Changes in Parathyroid Hormone and Calcium Levels

Changes in Parathyroid Hormone and Calcium Levels after Superior Cervical Ganglionectomy of Rats
23-26 h after SCGx there is a significant impairment of homeostatic iPTH responses to low Ca levels which can be overcome by suitable Ca stimulus; (3) circulating catecholamines may affect denervated parathyroid cells, as revealed by the changes in serum iPTH and Ca elicited by alpha- and beta-adrenoceptor-blocker treatment of SCGx rats.

Daniel P. Cardinali, Marta G. Ladizesky
Logo
Vol. 40, No. 4, 1985

Amygdala and aversive conditioning

Lesioned rats and controls were again tested for aversive conditioning to explicit and contextual cues. Rats with cell body lesions of the hippocampus showed normal suppression of drinking in the presence of the conditioned stimulus, but were severely impaired in choosing the safe environment based on contextual cues alone. These results suggest a double dissociation of the effects of amygdala and hippocampal damage on fear conditioning to explicit and contextual cues.
Department of Experimental Psychology, University of Cambridge, U.K.

Neuroscience. 1991 ;42:335-50 1832750

Sympathectomy resulted in 2- to 5-fold increases in NGF protein levels in heart atrium and ventricle

Peripheral sympathectomy carried out in the adult rat resulted in 2- to 5-fold increases in NGF protein levels in heart atrium and ventricle, as well as submandibular gland, with no concomitant increase in NGF mRNA.
S R Whittemore, L Lärkfors, T Ebendal, V R Holets, A Ericsson, H Persson
J Neurosci. 1987 Jan ;7 (1):244-51 3806196

Sympathectomy Attenuates the Maintenance but Not Initiation of L-NAME– Induced Hypertension

We measured intra-arterial pressure in conscious, unrestrained rats with and without guanethidine-induced sympathectomy during varying durations of intravenous N-nitro-L-arginine methyl ester (L-NAME). The major new finding is that sympathectomy had no effect on the hypertensive response to bolus injections of L-NAME but in the same rats it produced a greater than 50% attenuation in the hypertension seen after 6 days of continuous L-NAME (change in mean arterial pressure, 23±4 versus 55±4 mm Hg,
P<.01, sympathectomy versus control). Using 8-hour infusions of L-NAME, we found that 60 minutes was the minimum time required for detecting a sympathectomy-sensitive component of L-NAME–induced hypertension. Furthermore, we demonstrate that the magnitude of this component increases further between 8 hours to 6 days of continuous L-NAME: it accounted for only 18% of the total hypertensive response at 8 hours but 61% after 6 days. From these experiments, we conclude that the importance of the sympathetic system in the pathogenesis of L-NAME–induced hypertension accrues slowly over hours and days, and thus its importance can be overlooked by focusing on the initial phase of the hypertension. (Hypertension. 1997;30[part 1]:64-70.) Sander, Mikael; Hansen, Jim; Victor, Ronald G.

Anti-inflammatory role of the sympathetic nerves

In all layers, Crohn’s disease patients demonstrated a loss of sympathetic nerve fibres. Sprouting of SP+ nerve fibres was particularly observed in the mucosa and muscular layer in Crohn’s disease.

http://gut.bmj.com/cgi/content/abstract/57/7/911

In a person who had a sympathectomy, the sympathetic component of the baroreceptor mechanism is absent.

A patient with a sympathectomy would experience what's referred to as orthostatic hypotension (which might lead to syncope). Orthostatic hypotension is a decrease in arterial pressure when going from supine to a standing position. A person with a normal baroreceptor mechanism will try to restore MAP. In a person who had a sympathectomy, the sympathetic component of the baroreceptor mechanism is absent.
M.A.S.T.E.R. Learning Program, UC Davis School of Medicine

Date Revised: Jan 16, 2002

Revised by: Gordon Li and Carolyn Nguyen

Sympathectomy causes ejaculatory dysfunction

We conclude that sympathectomy delays the transit of sperm through the cauda epididymidis and produces ejaculatory dysfunction but does not compromise sperm quality in the distal cauda epididymidis.
Biology of Reproduction 59, 897-904 (1998)

http://www.biolreprod.org/cgi/content/full/59/4/897

Sympathectomy reduces catecholamines

Sympathectomy has been used to study the role of the sympathetic nervous system in the control of gastric acid secretion. Conflicting results may reflect differences in the sympathectomy procedures used. In a previous study we showed a reduction of catecholamines by more than 90% in the gut wall of the rat after surgical upper abdominal sympathectomy.
Scand J Gastroenterol. 1985 Dec;20(10):1276-80.
http://www.ncbi.nlm.nih.gov/pubmed/4095497