Bilateral Brachial Plexus Injury After MiraDry Procedure for Axillary Hyperhidrosis

Ross C. Puffer, Allen Thorp Bishop, Robert J. Spinner, Alexander Yong-Shik Shin

Research output: Contribution to journalArticle

Abstract

Background: Multiple treatments are available for primary axillary hyperhidrosis including noninvasive, microwave-based thermal treatments designed to destroy sweat glands in the axilla. Often these procedures involve local anesthetic injection to the axilla, followed by placement of the microwave emitter onto the skin and applying the heat treatment to varying depths of the subcutaneous tissues. Case Description: A 49-year-old, thin, active woman (body mass index 19.6) underwent microwave-based treatment to the bilateral axillary regions. She experienced an electric sensation into the ulnar digits of the right hand during anesthetic injection and then underwent the microwave thermal treatment. She suffered a bilateral brachial plexus injury with imaging evidence of severe, subcutaneous edema surrounding the nerves of the plexus in the axilla, as well as denervation atrophy of the arm and forearm muscles bilaterally. At the time of evaluation and electromyography, 8 months after treatment, she had recovered significant strength in the left upper extremity but continued to have evidence of a severe radial nerve injury on the right. Electromyography demonstrated some recovery, and observation was recommended followed by secondary reconstruction if required. It is likely that the patient sustained thermal injury to the nerves in the axilla bilaterally, given the close proximity to the skin surface in a patient with a low body mass index. Conclusions: In thin patients undergoing treatment of primary axillary hyperhidrosis, consideration should be given to the distal brachial plexus, which may be at risk of damage with high-powered microwave-based therapy.

Original languageEnglish (US)
Pages (from-to)370-372
Number of pages3
JournalWorld neurosurgery
Volume124
DOIs
StatePublished - Apr 1 2019

Fingerprint

Arm Injuries
Hyperhidrosis
Brachial Plexus
Microwaves
Axilla
Hot Temperature
Electromyography
Therapeutics
Body Mass Index
Radial Nerve
Sweat Glands
Skin
Injections
Subcutaneous Tissue
Wounds and Injuries
Denervation
Local Anesthetics
Forearm
Upper Extremity
Atrophy

Keywords

  • Axillary hyperhidrosis
  • Bilateral brachia plexus injury
  • MiraDry

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology

Cite this

Bilateral Brachial Plexus Injury After MiraDry Procedure for Axillary Hyperhidrosis. / Puffer, Ross C.; Bishop, Allen Thorp; Spinner, Robert J.; Shin, Alexander Yong-Shik.

In: World neurosurgery, Vol. 124, 01.04.2019, p. 370-372.

Research output: Contribution to journalArticle

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