Stellate ganglion | |
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Details | |
From | inferior cervical ganglion, first thoracic ganglia |
Identifiers | |
Latin | ganglion cervicothoracicum, ganglion stellatum |
MeSH | D013233 |
TA98 | A14.3.01.020 |
TA2 | 6612 |
FMA | 6469 |
Anatomical terms of neuroanatomy |
The stellate ganglion (or cervicothoracic ganglion [1] ) is a sympathetic ganglion formed by the fusion of the inferior cervical ganglion and the first thoracic (superior thoracic sympathetic) ganglion, [2] which is present in 80% of individuals. Sometimes, the second and the third thoracic ganglia are included in this fusion.
The stellate ganglion is polygonal in shape (Latin : stellatum, lit. 'star-shaped'). It is relatively big (10–12 × 8–20 mm) compared to the much smaller thoracic, lumbar, and sacral ganglia.
Stellate ganglion is located at the level of C7, anterior to the transverse process of C7 and the neck of the first rib, superior to the cervical pleura and just below the subclavian artery. It is superiorly covered by the prevertebral lamina of the cervical fascia and anteriorly in relation with common carotid artery, subclavian artery and the beginning of vertebral artery which sometimes leaves a groove at the apex of this ganglion (this groove can sometimes even separate the stellate ganglion into so called vertebral ganglion).
Relations of the apex of the stellate ganglion:
The stellate ganglia may be cut in order to decrease the symptoms exhibited by Raynaud's phenomenon and hyperhydrosis (extreme sweating) of the hands. Injection of local anesthetics near the stellate ganglion can sometimes mitigate the symptoms of sympathetically mediated pain such as complex regional pain syndrome type I (reflex sympathetic dystrophy), and symptoms associated with alterations in arousal and reactivity (Criterion E) of PTSD. Injection is often given near the Chassaignac's tubercle (anterior tubercle of transverse process of C6) due to this being an important landmark lateral to the cricoid cartilage. It is thought that anesthetic is spread along the paravertebral muscles to the stellate ganglion.
Stellate ganglion block also shows great potential as a means of reducing the number of hot flashes and night awakenings suffered by breast cancer survivors and women experiencing severe symptoms of menopause. [3]
There has been interest in using stellate ganglion blocks to treat PTSD, particularly in combat veterans. A 2017 review of the evidence from the VA Evidence-based Synthesis Program found that while the procedure had been reported as effective in unblinded case series, the evidence from randomized controlled trials remained inconclusive. [4]
Nerve fibers from the stellate ganglion go up the superior cervical sympathetic chain and into the pterygopalatine (sphenopalatine) ganglion (SPG). SPG blocks have been shown to reduce anxiety, headaches, migraines, cancer pain and other disorders. [5] Self-administration of SPG blocks (SASPGB) is another method of delivering sphenopalatine blockade and indirect stellate ganglion blockade.
Complications associated with a stellate ganglion block include Horner's syndrome, accidental intra-arterial or intravenous injection, difficulty swallowing, vocal cord paralysis, epidural spread of local anaesthetic, and pneumothorax.
Blunt needling of the stellate ganglion with an acupuncture needle is used in traditional Chinese medicine to decrease sympathetically mediated symptoms as well.[ citation needed ]
Block of the stellate ganglion has also been explored in coronary artery bypass surgery, [6] as well as posttraumatic stress disorder. [7]
Left stellectomy is a treatment strategy in prolonged QT syndrome because activity of the stellate ganglia drives prolonged QT. However, this therapy is only offered to patients who are already on a beta blocker and experience frequent shocks from an implantable cardioverter-defibrillator (ICD), because stellectomy causes Horner's syndrome.
The stellate ganglion lies in front of the neck of the first rib, and posterior to the common carotid artery. [8] The vertebral artery lies anterior to the ganglion as it has just originated from the subclavian artery. After passing over the ganglion, the artery enters the vertebral foramen and lies posterior to the anterior tubercle of C6 (Chassaignac's tubercle). [9]
The vagus nerve, also known as the tenth cranial nerve, cranial nerve X, or simply CN X, is a cranial nerve that carries sensory fibers that create a pathway that interfaces with the parasympathetic control of the heart, lungs, and digestive tract. It comprises two nerves—the left and right vagus nerves—but they are typically referred to collectively as a single subsystem. The vagus is the longest nerve of the autonomic nervous system in the human body and comprises both sensory and motor fibers. The sensory fibers originate from neurons of the nodose ganglion, whereas the motor fibers come from neurons of the dorsal motor nucleus of the vagus and the nucleus ambiguus. The vagus was also historically called the pneumogastric nerve.
Articles related to anatomy include:
In human anatomy, the subclavian arteries are paired major arteries of the upper thorax, below the clavicle. They receive blood from the aortic arch. The left subclavian artery supplies blood to the left arm and the right subclavian artery supplies blood to the right arm, with some branches supplying the head and thorax. On the left side of the body, the subclavian comes directly off the aortic arch, while on the right side it arises from the relatively short brachiocephalic artery when it bifurcates into the subclavian and the right common carotid artery.
A Pancoast tumor is a tumor of the apex of the lung. It is a type of lung cancer defined primarily by its location situated at the top end of either the right or left lung. It typically spreads to nearby tissues such as the ribs and vertebrae. Most Pancoast tumors are non-small-cell lung cancers.
In tetrapods, cervical vertebrae are the vertebrae of the neck, immediately below the skull. Truncal vertebrae lie caudal of cervical vertebrae. In sauropsid species, the cervical vertebrae bear cervical ribs. In lizards and saurischian dinosaurs, the cervical ribs are large; in birds, they are small and completely fused to the vertebrae. The vertebral transverse processes of mammals are homologous to the cervical ribs of other amniotes. Most mammals have seven cervical vertebrae, with the only three known exceptions being the manatee with six, the two-toed sloth with five or six, and the three-toed sloth with nine.
The vertebral arteries are major arteries of the neck. Typically, the vertebral arteries originate from the subclavian arteries. Each vessel courses superiorly along each side of the neck, merging within the skull to form the single, midline basilar artery. As the supplying component of the vertebrobasilar vascular system, the vertebral arteries supply blood to the upper spinal cord, brainstem, cerebellum, and posterior part of brain.
The pterygopalatine ganglion is a parasympathetic ganglion in the pterygopalatine fossa. It is one of four parasympathetic ganglia of the head and neck,.
In anatomy, the left and right common carotid arteries (carotids) are arteries that supply the head and neck with oxygenated blood; they divide in the neck to form the external and internal carotid arteries.
The scalene muscles are a group of three muscles on each side of the neck, identified as the anterior, the middle, and the posterior. They are innervated by the third to the eighth cervical spinal nerves (C3-C8).
The thyrocervical trunk is an short artery of the neck. It arises from the subclavian artery, then promptly divides into its branches: the inferior thyroid artery, suprascapular artery, and (sometimes) the transverse cervical artery.
The superior cervical ganglion (SCG) is the upper-most and largest of the cervical sympathetic ganglia of the sympathetic trunk. It probably formed by the union of four sympathetic ganglia of the cervical spinal nerves C1-C4. It is the only ganglion of the sympathetic nervous system that innervates the head and neck. The SCG innervates numerous structures of the head and neck.
A cervical rib in humans is an extra rib which arises from the seventh cervical vertebra. Their presence is a congenital abnormality located above the normal first rib. A cervical rib is estimated to occur in 0.2% to 0.5% of the population. People may have a cervical rib on the right, left or both sides.
The sympathetic ganglia, or paravertebral ganglia are autonomic ganglia, of the sympathetic nervous system. Ganglia are 20,000 to 30,000 afferent and efferent nerve cell bodies that run along on either side of the spinal cord. Afferent nerve cell bodies bring information from the body to the brain and spinal cord, while efferent nerve cell bodies bring information from the brain and spinal cord to the rest of the body. The cell bodies create long sympathetic chains that are on either side of the spinal cord. They also form para- or pre-vertebral ganglia of gross anatomy.
The costocervical trunk arises from the upper and back part of the second part of subclavian artery, behind the scalenus anterior on the right side, and medial to that muscle on the left side.
The middle cervical ganglion is the smallest of the three cervical sympathetic ganglia. It presumably represents the merging of the sympathetic ganglia of cervical segments C5-C6. It is usually situated at the level of the sixth cervical vertebra.
The inferior cervical ganglion is one of the three cervical sympathetic ganglia. It situated between the base of the transverse process of the last cervical vertebra and the neck of the first rib, on the medial side of the costocervical artery.
The cervical ganglia are paravertebral ganglia of the sympathetic nervous system. Preganglionic nerves from the thoracic spinal cord enter into the cervical ganglions and synapse with its postganglionic fibers or nerves. The cervical ganglion has three paravertebral ganglia:
The lumbar ganglia are paravertebral ganglia located in the inferior portion of the sympathetic trunk. The lumbar portion of the sympathetic trunk typically has 4 lumbar ganglia. The lumbar splanchnic nerves arise from the ganglia here, and contribute sympathetic efferent fibers to the nearby plexuses. The first two lumbar ganglia have both white and gray rami communicates.
Subclavian loop, also known as Vieussens' ansa after French anatomist Raymond Vieussens (1635-1715), is a nerve cord that is a connection between the middle and inferior cervical ganglion which is commonly fused with the first thoracic ganglion and is then called the stellate ganglion. The subclavian ansa forms a loop around the subclavian artery; whence its name. This communicating branch downwards anteromedial to the vertebral artery makes a loop around the subclavian artery from anterior to posterior and then lies medially to the internal thoracic artery respectively. Sometimes there are two communicating branches encompassing the vertebral artery, one from anterior and the other from posterior.
The following outline is provided as an overview of and topical guide to human anatomy: