Inferior Cervical Ganglion and Stellate Ganglion- Concepts Revisited

Abstract

BACKGROUND Awareness of the regional anatomy of the cervical sympathetic chain may help the surgeons in identifying and preserving this structure during related surgical procedures. Care must be taken by the spinal surgeon to protect the chain and its branches, while dissecting the longus colli muscle especially in the root of neck for anterior spinal surgeries. 1 The present study aims to define the lower two ganglia, i.e. inferior cervical ganglion and stellate ganglion by tracing their vascular relations, dimensions and branches. The frequency of occurrence of these ganglia, which is surgically significant is also studied. MATERIALS AND METHODSThe study was descriptive, done in 50 cervical sympathetic chains by bilateral neck dissection of 25 adult cadavers in the Department of Anatomy, Medical College, Thiruvananthapuram. The superior cervical ganglion (SCG), inferior cervical ganglion (ICG), stellate ganglion (SG) and the intermediate ganglia were carefully dissected out and studied. RESULTSSCG was seen in 100% cases, middle inferior ganglion (MCG) in 44%, vertebral ganglion (VG) in 72%, ICG in 72% cases and stellate ganglion in 28% chains. The branches arising from the ganglia were Gray rami communicantes (GRC), vascular branches and medial visceral branches. Vertebral nerve from ICG was present in 4% cases and from stellate in 2% cases. CONCLUSIONIn the lower part of cervical sympathetic chain, ICG is more frequently present than SG. KEYWORDSCervical Sympathetic Chain, Cervical Sympathetic Ganglia, Inferior Cervical Ganglion, Stellate Ganglion, Vertebral Nerve. HOW TO CITE THIS ARTICLE: Raveendran VL, Kamalamma GK. Inferior cervical ganglion and stellate ganglion-concepts revisited. J. Evolution Med. Dent. Sci. 2018;7(13):1653-1658, DOI: 10.14260/jemds/2018/373 BACKGROUND The cervical sympathetic chain lies ventral to the transverse process of the cervical vertebrae and dorsal to the carotid vessels. It extends from the base of the skull to the level of the neck of first rib, where it continues as the thoracic sympathetic chain. The classical chain was described as having 3 ganglion masses named as superior cervical ganglion, middle cervical ganglion and inferior cervical ganglion or cervico-thoracic ganglion. The varying frequency of occurrence of ICG and SG is mentioned in the previous studies, leaving a questionable concept that will the ICG and first thoracic ganglion almost universally fused to form the stellate ganglion.The ganglia in the cervical region were named as "ganglion cervical medium" and "ganglion cervicothoracicum" or "ganglion stellatum" in the International Anatomical Nomenclature Committee [Nomina Anatomica, Paris (1955)]. The term "inferior cervical ganglion" had been discarded in Nomina Anatomica and was justified by the fact that the "inferior cervical ganglion" appeared only exceptionally as an independent formation. 2 'Financial or Other Competing Interest': None. Submission 17-02-2018, Peer Review 12-03-2018, Acceptance 19-03-2018, Published 26-03-2018. Corresponding...

The “question-mark” MR anatomy of the cervico-thoracic ganglia complex: can it help to avoid mistaking it for a malignant lesion on 68Ga-PSMA-11 PET/MR?

“…At the border of the chest and neck, the sympathetic inferior cervical ganglion (ICG) and the first thoracic ganglion (T1), may fuse to form a relatively large, variedly shaped, cervico-thoracic ganglion (CTG), called also the stellate ganglion (SG) (Figure 1A). Reported percentages of such fusions were scattered from 28% by Raveendran and Kamalamma1 through about 82–83%2,3; up to 100% according to Hoffman 4…”

“…The exact location of CTG/SG had been studied in detail on cadavers1, 2, 3,5, 6, 7 to find reliable anatomic landmarks for the needs of their therapeutic block or ablation to relieve pain, in different diseases including cardio-vascular and post-traumatic stress disorder8, 9, 10 or to assist avoiding their iatrogenic damage during surgery.…”