Thoracoscopic and Anatomic Landmarks of Kuntz's Nerve: Implications for Sympathetic Surgery

Thoracoscopic excision of the sympathetic chain: an easy and effective treatment for hyperhidrosis in children

“…The Kuntz's nerves are sympathetic fibres that reach the brachial plexus without passing through the sympathetic trunk, and their prevalence varies considerably between surgical and anatomic literature. Clinical studies describe Kuntz's nerve in about 10% of cases, whereas anatomic investigations report Kuntz's nerves in up to 80% [12]. Other series report recurrence rates between 1 and 27% of the patients at 3 years after surgery [13] with 75% of recurrences presenting in the first 6 post-operative months, and its intensity in the majority of cases is moderate.…”

Nerves of the Upper Extremity

“…It has been found that the fibers from the second to eighth thoracic levels may participate in the sympathetic innervation of the upper extremity, although a narrow number of thoracic levels has also been suggested (Cho et al 2005;Zhang et al 2009). A variant communication from the second thoracic level to the brachial plexus, commonly referred to as the nerve of Kuntz (1927), may exist in 12-68% of individuals (12%, Marhold et al 2008;34%, Ramsaroop et al 2001;67%, Marhold et al 2008;68%, Chung et al 2002), which has been found less commonly in intraoperative series (Marhold et al 2008).…”

Endoscopic thoracic sympathectomy for posttraumatic complex regional pain syndrome

“…The most well-known anatomic variation is the nerve of Kuntz, which is an inconstant intrathoracic ramus connecting the first and second thoracic nerves that reaches the brachial plexus without passing through the sympathic trunk [24][25][26]. When performing a sympathectomy, it is important that this alternate sympathic connection is severed, because this increases the probability of better sympathic denervation of the upper limb and reduces the risk of recurrence [23].…”

“…We advocate a severance over the second rib across 3 cm lateral to the sympathic trunk, which is beyond the expected location of the nerve of Kuntz. According to Marhold et al [25], there is a very low thoracoscopic detection rate of the nerve of Kuntz [25]. Therefore, we did not make the effort to identify and localize these small nerve fibers.…”