Anatomical variation of the sympathetic trunk and aberrant rami communicantes and their clinical implications

ElsevierVolume 245, January 2023, 151999Annals of Anatomy - Anatomischer AnzeigerAbstract

Surgical interventions involving the sympathetic trunk are increasingly performed to alleviate symptoms of several disorders such as hyperhidrosis. Anatomical variation has been highlighted as one of the main causes behind surgical failure and symptoms recurrence following surgeries conducted on the chain or its surroundings. This study therefore aimed to record anatomical variants within spinal segments C8-T10 of the sympathetic trunk. Thirty Thiel-embalmed cadavers were investigated bilaterally. The stellate ganglion was recorded on 29 sides. Its size was significantly greater in males and on the right side when the coalescence extended to the subsequent ganglion. The intrathoracic nerve of Kuntz was observed on 21 sides and was significantly more prevalent in males. There was a significant positive association between the presence of this nerve and the descending ramus in the first intercostal space. Aberrant rami found between spinal root C8 and the ventral ramus of the first intercostal nerve were introduced as rami communicantes superi. Aberrant rami communicantes were recorded 50 times in total, of which 70% were found in males. Descending rami showed the highest prevalence in upper intercostal levels, especially in males within the first intercostal space. Aberrant neuronal pathways in upper levels were significantly more prevalent when the stellate ganglion was present. The scientific literature has proven to be stochastic as results were significantly higher in past studies in regard to some sympathetic variants. Anatomical findings of the current study as well as the inconsistency of previous data should be acknowledged and considered for better surgical planning.

AbbreviationsSRc

Rami communicantes superi

SIR

Intrathoracic Ramus/Rami superi

SAR

Ascending Ramus/Rami superi

SDR

Descending Ramus/Rami superi

IR

Intrathoracic Ramus/Rami

SG

Stellate Ganglion/Ganglia

INK

Intrathoracic Nerve(s) of Kuntz

ICG

Inferior Cervical Ganglion/Ganglia

ANS

Autonomic Nervous System

GS

Greater Splanchnic (nerve)

ETS

Endoscopic Thoracic Sympathectomy

TSE

Thiel Soft-Fix Embalming

DAP

Distal Attachment Point

T1

First Thoracic Ganglion (applies to all thoracic ganglia)

1IC

First Intercostal nerve (applies to all intercostal nerves)

Keywords

Sympathetic trunk

Stellate ganglion

Kuntz nerve

Variation

Surgical failure

Thiel

© 2022 The Author(s). Published by Elsevier GmbH.

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