Surgical anatomy of cervical sympathetic trunk: a cadaveric study
DOI:
https://doi.org/10.18203/2320-6012.ijrms20220282Keywords:
Cervical sympathetic chain, Cervical sympathetic trunk, Cervical sympathetic ganglia, Stellate ganglion, Sympathetic chain, Sympathetic trunkAbstract
Background: Cervical sympathetic trunk (CST) is at risk of injury during surgical procedures of cervical spine and may result in Horner’s syndrome. The purpose of present study was to clearly describe the surgical anatomy of CST with respect to the surrounding structures and to analyse the anatomical variations.
Methods: In this cross-sectional study, 50 cervical sympathetic chains were studied by bilateral neck dissections of 25 formalin fixed human cadavers from the Department of Anatomy, Government medical college Thrissur.
Results: Cervical sympathetic chain was found inside the carotid sheath in 1 (2%) side of neck. Superior cervical ganglion (SCG) was consistently seen in all sympathetic chains. Middle cervical ganglion (MCG) was present in 27 (54%) chains studied; vertebral ganglion (VG) was present in 33 (66%) chains. Inferior cervical ganglion (ICG) was present in 38 (76%) CSTs. In case of stellate ganglion (SG), it was present in 12 (24%) chains. The most common type of CST was type 1 consisting of SCG, VG and ICG (17, 34%). Out of 25 cadavers studied, sympathetic chain appeared similar on right and left sides in 14 cadavers.
Conclusions: This study concludes that variations occur in cervical sympathetic chain with regard to occurrence and measurements of its ganglia. Our study also emphasizes the need for awareness of the CST’s anatomy during cervical surgical procedures to prevent inadvertent injury to it.
Metrics
References
Kulkarni NV. Clinical anatomy for students. 3rd ed. New Delhi: Jaypee publishers; 2016.
Laubmann W. Anatomische Studie über den Halssympathicus des Menschen. Zeitschrift für Anatomie und Entwicklungsgeschichte. 1931;96(5-6):787-805.
Telford ED. The technique of sympathectomy. Brit J Surg. 1935;23(90):448-50.
Sheehan D. On the innervation of the blood-vessels of the upper extremity: some anatomical considerations. Brit J Surg. 1933;20(79):412-24.
Saylam CY, Ozgiray E, Orhan M, Cagli S, Zileli M. Neuroanatomy of cervical sympathetic trunk: a cadaveric study. Clin Anat. 2009;22(3):324-30.
Civelek E, Karasu A, Cansever T, Hepgul K, Kiris T, Sabanci A, et al. Surgical anatomy of the cervical sympathetic trunk during anterolateral approach to cervical spine. Eur Spine J. 2008;17(8):991-5.
Lyons AJ, Mills CC. Anatomical variants of the cervical sympathetic chain to be considered during neck dissection. Brit J Oral Maxillofac Surg. 1998;36(3):180-2.
Ebraheim NA, Lu J, Yang H, Heck BE, Yeasting RA. Vulnerability of the sympathetic trunk during the anterior approach to the lower cervical spine. Spine. 2000;25(13):1603-6.
Kiray A, Arman C, Naderi S, Guvencer M, Korman E. Surgical anatomy of the cervical sympathetic trunk. Clin Anat. 2005;18(3):179-85.
Becker RF, Grunt JA. The cervical sympathetic ganglia. Anat Rec. 1957;127(1):1-14.
Kimmel DL. The cervical sympathetic rami and the vertebral plexus in the human fetus. J Comparit Neurol. 1959:112-41.
Ellison JP, Williams TH. Sympathetic nerve pathways to the human heart, and their variations. Am J Anat. 1969;124(2):149-62.
Yin Z, Yin J, Cai J, Sui T, Cao X. Neuroanatomy and clinical analysis of the cervical sympathetic trunk and longus colli. J Biomed Res. 2015;29(6):501-7.
Fazliogullari Z, Kilic C, Karabulut AK, Yazar F. A morphometric analysis of the superior cervical ganglion and its surrounding structures. Surg Radiol Anat. 2016;38(3):299-302.
Kalsey GMRN, Patnaik VVG. A comparative study of cervical sympathetic chain. J Anatomic Soc. 2000;49(1):26-30.
Kuntz A. Distribution of the sympathetic rami to the brachial plexus. Arch Surg. 1927;15(6):871-7.
Hoffman HH. An analysis of the sympathetic trunk and rami in the cervical and upper thoracic regions in man. Ann Surg. 1957;145(1):94-103.
Standring S. Gray's anatomy: the anatomical basis of clinical practice. 40th ed. Elsevier Health Sciences; 2008.
Mitchell GAG. Anatomy of the autonomic nervous system. Livingstone; Elsevier; 1953:356.
Wrete M. The anatomy of the sympathetic trunks in man. J Anat. 1959;93:448-59.
White JC, Smithwick RH, Simeone FA. The autonomic nervous system. 3rd ed. The Macmillan Company; 1952.
Woollard HH, Norrish RE. The anatomy of the peripheral sympathetic nervous system. Brit J Surg. 1933;21(81):83-103.
Standring S. Gray's anatomy: the anatomical basis of clinical practice. 41th ed. Elsevier Health Sciences; 2017.
Perlow S, Vehe KL. Variations in the gross anatomy of the stellate and lumbar sympathetic ganglia. Am J Surg. 1935;30(3):454-8.
Zhang B, Li Z, Yang X, Li G, Wang Y, Cheng J, et al. Anatomical variations of the upper thoracic sympathetic chain. Clin Anat. 2009;22(5):595-600.