Ultrasound guided injections of botulinum toxin type A into stellate ganglion to treat insomnia

Ding, Xiwei; Ding, Zhigang; Wang, Wei; Yan-ping, Liu; Zhong, Jing

doi:10.3892/etm.2017.4612

Experimental and Therapeutic Medicine

2017

DOI: 10.3892/etm.2017.4612

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Ultrasound guided injections of botulinum toxin type A into stellate ganglion to treat insomnia

Xiwei Ding

Zhigang Ding

Wei Wang

et al.

Abstract: The aim of the study was to investigate the curative effect of botulinum toxin type A (BTX-A) injection into stellate ganglion under ultrasound guidance in patients suffering from insomnia. From October 2015 to April 2016, 48 patients suffering from insomnia were enrolled in this study. Patients were divided into 2 groups using a random digital grouping method: i) Control group (24 cases), and ii) treatment group (24 cases). Patients in the control group received 1 mg oral estazolam 30 min before sleep every n… Show more

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Cited by 3 publications

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Cadaveric and ultrasonographic morphometry of cervicothoracic ganglion (Stellate ganglion)

Kulkarni,

Mhetre,

Kalyankar

et al. 2024

IJCAP

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: Stellate ganglion block (SGB) inhibits sympathetic innervation and is a common treatment for reflex sympathetic dystrophy. During the positioning of the needle, there is a risk of injury to the adjacent structures. Cardiac sympathetic denervation (CSD) to treat ventricular arrhythmias (VAs) requires transection at the middle or lower third of stellate (cervicothoracic) ganglia (SG). However, the morphological appearance of the adult SG and its distribution are not well described. : To determine the morphology of left and right SG (LSG and RSG) and their relations with adjacent structures. 1. Cadaveric: LSG and RSG (n=30) from 15 embalmed adult cadavers were dissected intact. Weights, volume, height, morphologic appearance, relationship between C8 and T1 ganglia (which form the SG) were determined. 2. Ultra-sonographic: Fifty adult patients enrolled for other than neck pathology evaluation were included. The size, shape, the relationship between the superior pole of SG and the transverse process of C7, the relationship between the superior pole of SG and the inferior thyroid artery, and the relationships between SG and other surrounding tissues were evaluated. 1. Cadaveric part: Three distinct morphologies of SG were identified: fusiform-rounded; fusiform-elongated; and bi-lobed. RSG and LSG did not differ in weight or volume. RSG were longer than LSG. Bi-lobed morphology was most common in RSGs while fused, elongated was most common in LSG 2. Ultra-sonographic part: it was difficult to visualize SG No significant differences found in thickness and cress-sectional area on right and left side. In fact, 60% of SGs were located in the C7 transverse process level, 75% of SGs were located under the inferior thyroid artery, and all of these SGs were located lateral to the thyroid gland and medial to the anterior scalene muscle and the vagus nerve.: Knowledge of the stellate ganglia’s morphology may help for greater precision and accuracy in the transection of the lower half to distal third of the SG during stellate ganglionectomy to treat cardiac arrhythmias. Ultra-sonographic guided SGB may improve safety and allows the visualization of the local anesthetic injection site. Studying the local anesthetic spread might allow the avoidance of side effects as well as typical complications of SGB. Thus, potentially improving both the safety and efficacy of the procedure.

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Cadaveric and ultrasonographic morphometry of cervicothoracic ganglion (Stellate ganglion)

Kulkarni,

Mhetre,

Kalyankar

et al. 2024

IJCAP

View full text Add to dashboard Cite

show abstract

Visualizing stellate ganglion with US imaging for guided SGB treatment: A feasibility study with healthy adults

Pu²,

Liu³

et al. 2022

Front. Neurosci.

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ObjectiveAs for ultrasound (US) guided stellate ganglion (SG) block, unsatisfactory curative outcomes and complications still remain. This problem could be greatly improved by identifying and monitoring SG. To the best of our knowledge, there are few reports to directly visualize SG in literature. This study explored the feasibility of detection of SG and summarized the findings of SG through US.MethodsFifty healthy adults with 100 SGs were enrolled. The size, shape, echogenicity, margin, the inferior pole of SG, the relationship between the superior pole of SG and the transverse process, the relationship between the superior pole of SG and the inferior thyroid artery, and the relationships between SG and other surrounding tissues were evaluated by US.ResultsThe SG was identified in 79% of the participants. No significant differences were found between the right and left sides regarding thickness, cross-sectional area (CSA), and position (all p > 0.05); however, there was a significant difference in the width of the right and left sides (p < 0.05). Side was associated with SG visibility (p < 0.05), however, the gender was not (p > 0.05). A total of 42% of SGs were oval-shaped. All SGs were hyperechogenic and had an ill-defined margin. In fact, 63% of SGs were located in the C7 transverse process level, 77% of SGs were located under the inferior thyroid artery, and all of these SGs were located lateral to the thyroid and medial to the anterior scalene muscle and the vagus nerve.ConclusionOur preliminary study demonstrates that US imaging provides the capability of detecting SG. This may be helpful in minimizing complications and improving the accuracy of US-guided SG block.

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Effects of Stellate Ganglion Block Through Different Approaches Under Guidance of Ultrasound

Shan

Chen

et al. 2022

Front. Surg.

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ObjectiveThis study aimed to investigate the effects of stellate ganglion block (SGB) through different approaches under guidance of ultrasound.MethodsA total of 130 patients undergoing SGB in our hospital between February 2019 and February 2020 were enrolled as the research subjects. According to the random number table method, these subjects were divided into two groups: a modified 6th cervical vertebra (C6) group (n = 65) and a 7th cervical vertebra (C7) group (n = 65). Under the guidance of ultrasound, the subjects in the modified C6 group were punctured at the level of the C6 transverse process, and the subjects in the C7 group were punctured at the level of the C7 transverse process. The operation duration, number of puncture angle adjustments, block effects, and adverse reactions for SGB were compared between the two groups.ResultsThe modified C6 group showed shorter SGB operation duration and a lower number of puncture angle adjustments than the C7 group, and the differences were statistically significant (P < 0.05). Horner Syndrome occurred in both groups after SGB. The incidence of adverse reactions in the modified C6 group was 4.62%, comprising 1 case of hoarseness and 2 cases of slowed pulse, while that in the C7 group was 6.15%, with 1 case of hoarseness and 3 cases of slowed pulse; the difference between the two groups was not statistically significant (P > 0.05).ConclusionThe operation duration for modified SGB guided by ultrasound puncturing at the C6 transverse process is shorter and requires fewer puncture angle adjustments than puncturing at the C7 transverse process; however, there is no significant difference between the incidence of adverse reactions or the blocking effects of the two methods.

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Ultrasound guided injections of botulinum toxin type A into stellate ganglion to treat insomnia

Cited by 3 publications

References 16 publications

Cadaveric and ultrasonographic morphometry of cervicothoracic ganglion (Stellate ganglion)

Cadaveric and ultrasonographic morphometry of cervicothoracic ganglion (Stellate ganglion)

Visualizing stellate ganglion with US imaging for guided SGB treatment: A feasibility study with healthy adults

Effects of Stellate Ganglion Block Through Different Approaches Under Guidance of Ultrasound

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