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, October 31, 2008

Sympathectomy disrupts feedback from the viscera

Researchers have examined the role of autonomic feedback in emotional experience using the heartbeat detection paradigm. Katkin et al. (1982) found that some normal subjects can accurately detect their heartbeats, and it was those individuals who had a stronger emotional response to negative slides as determined by self-report (hantas et al. 1982)
Experiments in animals demonstrate that sympathectomy may retard aversive conditioning (DiGusto and King, 1972) most likely because sympathectomy reduces fear.
In order for feedback to occur, there must be a means for the viscera and autonomic nervous system to become activated.

Degeneration patterns of postganglionic fibers following sympathectomy

In the muscle nerves the first signs of an axonal degeneration of the sympathetic fibers can be recognized 4 days after surgery. The signs of axonal degeneration are most striking about 8 days p.o. They have more or less disappeared another week later. The reactions of the Schwann cells also start on the fourth day but outlast the degenerative processes by some 8 days. Thus the degenerative and reactive processes in the reg precede those in the muscle nerves by 2 days early after surgery and by 6 days 3 weeks later. Seven weeks after surgery, fragments of folded basement lamella and Remak bundles with condensed cytoplasm and numerous flat processes are persisting signs of the degeneration.
K. H. Andres, M. von Düring, W. Jänig and R. F. Schmidt
Anatomy and Embryology
Springer Berlin / Heidelberg
Volume 172, Number 2 / August, 1985
http://www.springerlink.com/content/m21m2612n2147011/

sympathectomy is associated with increased pulmonary metastases

Chemical sympathectomy is associated with increased pulmonary metastases.

Journal of Neuroimmunology 1992;37:191-202.
Brenner, GJ, Felten, SY, Felten, DL, Cohen, N and Moynihan, JA.
http://www.massgeneral.org/nprg/brenner.htm

sympathectomy involves division of adrenergic, cholinergic and sensory fibers

The excision of neural structures which elaborate adrenergic substances during the process of regulating visceral function continues to be a valuable investigative and therapeutic maneuver.
In general, sympathtectomy has been used for one or more of the following purposes:
1/ to eliminate tonic or engendered responses which depend upon impulses in adrenergic nerves;
2/ to eliminate visceral stores of adrenergic substances which depend upon the integrity of the postganglionic sympathetic innervation;
3/ to eliminate postganglionic sympathetic tissue as a locus for the synthesis, uptake, binding, release and metabolism of adrenergic substances;
4/ to eliminate visceral afferent fibers which are frequently distributed in common with autonomic nerves.
It is clear that sympathectomy is not a selective excision of adrenergic elements only. It is well recognized that preganglionic sympathectomy involves division of cholinergic elements and sensory fibers.
Although the larger portion of sympathetic inflow to an organ can be eliminated by excision of relatively large, well defined anatomical structures in the sympathetic nervous system, there may be many aberrant pathways of innervation. The structure of the terminal apparatus for innervation in most organs is not clear, and it is not known how widely or how rapidly a seemingly small residue of postganglionic fibers can proliferate or branch to occupy sites of degenerated elements.
Theodore Cooper
Surgical Sympathectomy and Adrenergic Function
Department of Surgery, St Louis University School of Medicine
Pharmacological Reviews, Vol. 18, No.1
http://pharmrev.aspetjournals.org/cgi/pdf_extract/18/1/611