Surgery of the sympathetic nervous system for the treatment of a myriad of diseases is approaching its 100th year. By the eighteenth century the gross anatomy of the sympathetic nervous system was well described, and its surgical manipulation has been studied for the treatment of myriad conditions. Though diverse indications have existed historically, ranging from epilepsy, angina pectoris, peripheral vascular disease, and systemic hypertension, the improvements in modern medical therapies have largely obviated the need for surgical intervention. Currently, sympathectomy is used in the treatment of complex regional pain syndrome, Raynaud's phenomenon, pelvic pain syndromes, and, most commonly, palmar hyperhidrosis. Modern research in sympathetic surgery includes renal sympathetic denervation and the treatment of social phobia and facial flushing.