Morphometric study of the upper thoracic sympathetic Ganglia

Abstract

Objective: Morphometric data for the sympathetic ganglia (SG) of the upper thoracic spine was investigated to identify the exact location of the SG in order to reduce normal tissue injury in the thoracic cavity during thoracoscopic sympathectomy.

Methods: In 46 specimens from 23 formalin-fixed adult cadavers, the authors measured the shortest distance from the medial margin of the T1, T2 and T3 SG to the most prominent point and medial margin of the corresponding rib heads, and to the lateral margin of the longus colli muscle. In addition, the distance between the most prominent point of the rib head and the lateral margin of longus colli muscle and the width of each SG were measured.

Results: The shortest distance from the medial margin of the SG to the prominent point of corresponding rib head was on average 1.9 mm on T1, 4.2 mm, and 4.1 mm on T2, T3. The distance from the medial margin of the SG to the medial margin of the corresponding rib head was 4.2 mm on T1, 5.9 mm, and 6.3 mm on T2, T3. The mean distance from the medial margin of the SG to the lateral margin of the longus colli muscle was 6.7 mm on T1, 8.8 mm, 9.9 and mm on T2, T3. The mean distance between the prominent point of the rib head and the lateral margin of the longus colli muscle was 4.8 mm on T1, 4.6 mm, and 5.9 mm on T2, T3. The mean width of SG was 6.1 mm on T1, 4.1 mm, and 3.1 mm on T2, T3.

Conclusion: We present morphometric data to assist in surgical planning and the localization of the upper thoracic SG during thoracoscopic sympathectomy.

Keywords: Sympathectomy; Sympathetic ganglia; Thoracic vertebrae; Thoracoscopy.

Fig. 1

Anatomical relationships and schematic view on the left upper thoracic area are shown after the removal of the parietal pleura. The red arrow-head markers indicate the prominent point of the 1st, 2nd, and 3rd rib heads. LC : longus coli muscle, SG : sympathetic ganglia, SA : subclavian artery.

Fig. 2

Anatomical relationships in the right upper thoracic area before the parietal pleura removed. The red arrow-head markers indicate the prominent points of the 1st, 2nd, 3rd, 4th and 5th rib heads. The crossing point (*) between T3-4 sympathetic chain and superior intercostal vein is shown.

Fig. 3

The schematic image shows each anatomical landmark surrounding the left T2 sympathetic ganglia. Each of the measured variables is indicated as arrow-dotted lines. The red arrow-head marker indicates the prominent points of the rib head. A : The shortest distance from the medial margin of the SG to the most prominent rib head point. B : The shortest distance from the medial margin of the SG to the medial margin of the rib head. C : The shortest distance from the medial margin of the SG to the lateral margin of the longus colli muscle. D : The shortest distance from the most prominent point of rib head to the lateral margin of the longus colli muscle. W : The width of each SG. LC : longus coli muscle, SG : sympathetic ganglia.