Surgery of the sympathetic nervous system: Review of 100 sympathetic ganglionectomies

Abstract

Raynaud's Disease: Twenty-three operations were performed on 10 patients; 11 for the lower extremity and 12 for the upper. Three of the cases were primarily scleroderma with secondary vasospasm and 2 were primarily Raynaud's disease with secondary scleroderma. The rest of the cases were typical Raynaud's disease. In all of the cases of Raynaud's disease the results were excellent. In the cases where scleroderma was primary the results were very good but not as good as in the other cases. Thromboangiitis Obliterans: There were 13 operations on 11 patients; 9 for the lower extremity and 4 for the upper. The immediate results were excellent in every case. Only one case has since come to major amputation. There was one death in this series following transabdominal sympathectomy. Chronic Arthritis: There were 23 operations on 10 patients; 15 for the upper extremity and 8 for the lower. There was one death following the transabdominal operation. This death, together with the one before reported, constitute the entire operative mortality from the lumbar operation. Both of these deaths occurred following transabdominal sympathectomy. Since we have adopted the extraperitoneal approach there have been no deaths. Seven of the patients have been distinctly improved. There have been 3 failures. Spastic Paraplegia: There have been 17 operations on 9 patients; 10 for the lower extremity and 7 for the upper. Of the 10 operations for the lower extremity, the results were classified as good in 6, fair in 2, and failures in 2. Of the 7 operations for the upper extremity, 2 were classed as fair and the other 5 as failures. Three cases of megacolon are reported in which left lumbar ganglionectomy was done. The results in all cases were entirely satisfactory. There were 5 cases of chronic constipation treated by left lumbar ganglionectomy; all of these have been entirely relieved. Traumatic Sympathalgia: There have been 6 cases; 3 male and 3 female. The operation has been performed 5 times for the upper extremity and once for the lower extremity. The results were classified as excellent in 4 cases, good in one case, fair in one case, the last 2 being cases in which the element of compensation was strong. Painful Amputation Stump: There have been 4 patients operated upon, all for the upper extremity. Three of these cases have been failures and one has had a fair result. Among the group of miscellaneous cases reported were 2 of atypical facial pain, one of epilepsy, one of varicose ulcer and one of angina pectoris. The cases of atypical pain in the face were very successful. The rest of the cases were unsuccessful. Anomalies of the lumbar sympathetic chain occur in about 20 per cent of cases. There may be multiple trunks or multiple ganglia, and at times fewer ganglia than normal are found. These anomalies may be overlooked and thus lead to incomplete denervation. Anomalies of the dorsal trunk are infrequent, but when they do occur may lead to technical difficulties in their removal. The trunk may lie quite anteriorly on the bodies of the vertebrae. These anomalies should always be borne in mind.