Neurosurgery notes/Anatomy/Peripheral nerves anatomy/Autonomic nerves/Sympathetic

Sympathetic

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Autonomic nerves
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Horner syndrome

Cervical ganglia

  • The stellate ganglion supplies the sympathetic innervation to the head and neck
  • The inferior cervical ganglion fuses with the first thoracic ganglion to form the cervical thoracic (stellate) ganglion
Superior cervical sympathetic ganglion Anterior tubercle of transverse process Cervical sympathetic trunk Vertebral a. Middle cervical ganglion Vertebral ganglion Ansa subclavia Subclavian artery Cervicothoracic/ Stellate Ganglion Trachea Lung

Thoracic ganglia

  • A group of 12 paravertebral sympathetic ganglia
  • Situated in the posterior mediastinum in the thorax
    • Located on either side of the vertebral column
    • As the thoracic sympathetic trunks descends in the posterior mediastinum
      • They are positioned posterior to the costal pleura, but anterior to the intercostal vessels and nerves.
      • They lie in front of the neck of the ribs, but gradually come to lie more medially on the posterolateral aspect of the thoracic vertebral bodies, until they enter the abdomen by passing posterior to the medial arcuate ligaments or the medial crura of the diaphragm.
  • These ganglia form part of the thoracic component of the sympathetic trunks,
  • First thoracic ganglion
    • In 80% of cases fuses with the inferior cervical ganglion to form a large cervicothoracic ganglion (a.k.a. stellate ganglion).
  • 12th thoracic ganglion
    • Is continuous with the lumbosacral ganglion.
  • All twelve thoracic ganglia interconnect with each other via interganglionic fibers within the sympathetic trunks and also communicate with the thoracic spinal nerves via the gray and white rami communicantes.
  • Branches from the thoracic ganglia can be grouped into two categories
      • Upper five thoracic ganglia comprise of postganglionic fibers which provide motor autonomic innervation to various thoracic viscera.
        • 1st thoracic ganglia
          • Facial hyperhidrosis
        • 2nd and 3rd thoracic ganglia
          • Palmar hyperhidrosis
        • 4th thoracic ganglia
          • Axillary hyperhidrosis
      Thoracic Sympathetic Trunk – Course, Relations, Ganglia and Its Branches – Earth's Lab
       
    • Lower seven thoracic ganglia include the greater, lesser and least (or lowest) splanchnic nerves.
      • Greater splanchnic nerve
        • Arises from the fifth to the ninth (T5 to T9) thoracic ganglia,
      • Lesser splanchnic nerve
        • Arises from tenth to eleventh (T10 to T11) thoracic ganglia
      • Least splanchnic nerve emanates from the twelfth (T12) thoracic ganglion.
      • All three splanchnic nerves course medially and ventrally, as they pierce through the crura of the diaphragm to end up synapsing in various ganglia in the prevertebral plexuses.
      • For instance, the greater and lesser splanchnic nerves go to the coeliac and aorticorenal ganglia inside the coeliac plexus, while the least splanchnic nerve ends up in the renal ganglion in the renal plexus.
      • Next, the postganglionic neurons reach out to various viscera for innervation and help in the motility and secretions of the gut.