Surgical anatomy of the cervical sympathetic trunk

Kiray, Amac; Arman, Candan; Naderi, Sait; Güvençer, Mustafa; Korman, Esin

doi:10.1002/ca.20055

Cited by 90 publications

(83 citation statements)

References 16 publications

(24 reference statements)

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“…The diameter at this site was reported to be 3-4 mm by Lyons and Mills [12], 2.7 ± 0.6 mm by Ebraheim et al [5], and 2.2 ± 0.7 mm by Kıray et al [11].…”

Section: Discussionmentioning

confidence: 86%

Surgical anatomy of the cervical sympathetic trunk during anterolateral approach to cervical spine

et al. 2008

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The sympathetic trunk is sometimes damaged during the anterior and anterolateral approach to the cervical spine, resulting in Horner's syndrome. No quantitative regional anatomy in fresh human cadavers describing the course and location of the cervical sympathetic trunk (CST) and its relation to the longus colli muscle (LCM) is available in the literature. The aims of this study are to clearly delineate the surgical anatomy and the anatomical variations of CST with respect to the structures around it and to develop a safer surgical method that will diminish the potential risk of CST injury. In this study, 30 cadavers from the Department of Forensic Medicine were dissected to observe the surgical anatomy of the CST. The cadavers used in this study were fresh cadavers chosen at 12-24 h postmortem. The levels of superior and intermediate ganglions of cervical sympathetic chain were determined. The distance of the sympathetic trunk from the medial border of LCM at C6, the diameter of the CST at C6 and the length and width of the superior and intermediate (middle) cervical ganglion were measured. Cervical sympathetic chain is located posteromedial to carotid sheath and just anterior to the longus muscles. It extends longitudinally from the longus capitis to the longus colli over the muscles and under the prevertebral fascia. The average distance between the CST and medial border of the LCM at C6 is 11.6 ± 1.6 mm. The average diameter of the CST at C6 is 3.3 ± 0.6 mm. Superior ganglion of CSC in all dissections was located at the level of C4 vertebra. The length and width of the superior cervical ganglion were 12.5 ± 1.5 and 5.3 ± 0.6 mm, respectively. The location of the intermediate (middle) ganglion of CST showed some variations. The length and width of the middle cervical ganglion were 10.5 ± 1.3 and 6.3 ± 0.6 mm, respectively. The CST's are at high risk when the LC muscle is cut transversely, or when dissection of the prevertebral fascia is performed. Awareness of the CST's regional anatomy may help the surgeon to identify and preserve it during anterior cervical surgeries.

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“…The diameter at this site was reported to be 3-4 mm by Lyons and Mills [12], 2.7 ± 0.6 mm by Ebraheim et al [5], and 2.2 ± 0.7 mm by Kıray et al [11].…”

Section: Discussionmentioning

confidence: 86%

Surgical anatomy of the cervical sympathetic trunk during anterolateral approach to cervical spine

et al. 2008

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“…vertebral ganglion were each observed in 33.3%. There was no difference between the number of superior and vertebral ganglia between the right and left sides (Kiray et al, 2005). The superior cervical ganglion was observed in all cases (100%), the MG was observed on 91.7%, and the vertebral ganglion was observed on 94.4% cases (Kawashima, 2005).…”

Section: Discussionmentioning

confidence: 91%

“…The route to the anterior cervical spine through a corridor surrounded by carotid artery laterally, and trachea and oesophagus medially, was realized to be safe (Cloward, 1958). Today it is used more commonly for the surgical treatment of other cervical spine diseases including cervical spondylotic myelopathy, tumor, infection, or trauma of the vertebral bodies (Kiray et al, 2005). The most frequent complication secondary to anterior approach has been known as the injury of the recurrent laryngeal and superior laryngeal nerves resulting in vocal cord paralysis (Smith and Robinson, 1958;Cloward, 1962;Jacobson, 1979;Saunders et al, 1991;An et al, 1994).…”

Section: Introductionmentioning

confidence: 99%

Neuroanatomy of cervical sympathetic trunk: A cadaveric study

et al. 2009

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To reduce the risk of iatrogenic injury to sympathetic chain during anterior and anterolateral approaches to the cervical spine, its location has to be well defined and known by surgeons. We analyzed the course of sympathetic chain and its ganglia from C7 up to its entry into the cranial base and its relationship mainly with the longus colli (LC). Formalin fixed 20 human cadavers were dissected under operating microscope. Measurement of the dimensions of the ganglia, distance of the trunk to the LC, and the angles identifying the course of the chain were performed. Superior and inferior cervical/cervicothoracic ganglion were observed in all specimens, the middle cervical ganglion was observed in 48% of the specimens. The middle ganglion consisted of two ganglia in 10% of the dissected sides. Forty percent of the inferior cervical/cervicothoracic ganglion was at the C7 level, 25% was at C7-Th1 disc level, and 35% was at Th1 level. Vertebral ganglion was detected in only 8% of the specimens. The course of the sympathetic trunk converges medially descending from upper cervical levels to the lower levels. Anterior surgical approach to the cervical spine is a commonly used procedure. Although Horner syndrome due to sympathetic injury is not a common sequence of cervical operations, our findings support the current few reports on the subject and should be useful to any surgeon who operates in the cervical region to avoid this uncommon complication.

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“…Pick [5] reported double middle cervical ganglion. Kiray et al [6], Ebraheim et al [7] and Katritsis et al [8] reported the incidence of middle cervical ganglion as 33.3%, 39.3% and 53.2% respectively. Ebraheim et al [7] reported the length and width of middle cervical ganglion as 9.7±2.1mm and 5.2±1.3mm, Kiray et al [6] reported mean length as 9.7±3.4mm and mean width as 5.0±1.1mm whereas the present case showed the length of middle cervical ganglion to be and mean width to be 5 mm, which was comparatively much higher than that reported by others.…”

Section: Discussionmentioning

confidence: 99%