Stellate ganglion

Stellate ganglion
Plan of right sympathetic cord and splanchnic nerves. (Stellate ganglion not visible, but region is shown.)
Details
From	inferior cervical ganglion, first thoracic ganglia
Identifiers
Latin	ganglion cervicothoracicum, ganglion stellatum
MeSH	A08.340.315.350.800
TA	A14.3.01.020
FMA	6469
*Anatomical terms of neuroanatomy* [edit on Wikidata]

The stellate ganglion (or cervicothoracic ganglion) is a sympathetic ganglion formed by the fusion of the inferior cervical ganglion and the first thoracic ganglion, which exists in 80% of cases. Stellate ganglion is located at the level of C7 (7th cervical vertebrae), anterior to the transverse process of C7, superior to the neck of the first rib, and just below the subclavian artery.

Clinical significance

The clinical significance of these ganglia is that they 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). 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 flushes and night awakenings suffered by breast cancer survivors and women experiencing extreme menopause.^[1]

Complications associated with a stellate ganglion block include Horner's syndrome, 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.

Block of the stellate ganglion has also been explored in coronary artery bypass surgery.^[2]

Anatomy

The stellate ganglion lies in front of the neck of the first rib. 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).^[3]

References

↑ Lancet, 2008
↑ Yildirim V, Akay HT, Bingol H, et al. (2007). "Pre-emptive stellate ganglion block increases the patency of radial artery grafts in coronary artery bypass surgery". Acta anaesthesiologica Scandinavica. 51 (4): 434–40. doi:10.1111/j.1399-6576.2006.01260.x. PMID 17378781.
↑ Raj, Practical Management of Pain, 3rd ed, pp656-657

Anatomy of the autonomic nervous system

Head

Sympathetic	Ciliary ganglion: roots Sensory Sympathetic Short ciliary

Parasympathetic	Ciliary ganglion: roots Sensory Parasympathetic Short ciliary Pterygopalatine ganglion: deep petrosal nerve of pterygoid canal branches of distribution: greater palatine inferior posterior nasal branches lesser palatine nasopalatine medial superior posterior nasal branches pharyngeal Submandibular ganglion Otic ganglion

Neck

Sympathetic	paravertebral ganglia: Cervical ganglia Superior Middle Inferior Stellate ganglion prevertebral plexus: Cavernous plexus Internal carotid

Chest

Sympathetic	paravertebral ganglia: Thoracic ganglia prevertebral plexus: Cardiac plexus Esophageal plexus Pulmonary plexus Thoracic aortic plexus splanchnic nerves: cardiopulmonary thoracic cardiac nerves: Superior Middle Inferior

Abdomen

Sympathetic	paravertebral ganglia: Lumbar ganglia prevertebral ganglia: Celiac ganglia Aorticorenal Superior mesenteric ganglion Inferior mesenteric ganglion prevertebral plexus: Celiac plexus Hepatic Splenic Pancreatic aorticorenal Abdominal aortic plexus Renal/Suprarenal Superior mesenteric Gastric Inferior mesenteric Spermatic Ovarian Superior hypogastric hypogastric nerve Superior rectal Inferior hypogastric Vesical Prostatic / Cavernous nerves of penis Uterovaginal Middle rectal splanchnic nerves: Lumbar splanchnic nerves

Enteric	Submucous plexus Myenteric plexus

Pelvis

Sympathetic	paravertebral ganglia: Sacral ganglia Ganglion impar splanchnic nerves: Sacral splanchnic nerves

Parasympathetic	splanchnic nerves: Pelvic splanchnic nerves

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