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

Thursday, July 26, 2012

Anthem medical policy for ETS surgery

  • Presence of medical complications or skin maceration with secondary infection; or
  • Significant functional impairment, as documented in the medical record.
Botulinum toxin is considered medically necessary in the treatment of secondary hyperhidrosis when the condition is related to surgical complications and both of the following criteria are met:
  • Presence of medical complications or skin maceration with secondary infection; and
  • Significant functional impairment, as documented in the medical record.
Treatment of primary axillary or palmar hyperhidrosis with endoscopic thoracic sympathectomy is consideredmedically necessary in the small subset of individuals with hyperhidrosis where both of the following criteria (1 and 2) have been met:
  1. It has been adequately documented that all efforts at nonsurgical therapy have failed; and
  2. Either of the following:
    • Presence of medical complications or skin maceration with secondary infection; or
    • Significant functional impairment, as documented in the medical records;
http://www.anthem.com/medicalpolicies/policies/mp_pw_a050005.htm