Neuroanatomy and clinical analysis of the cervical sympathetic trunk and longus colli

Anterior cervical surgery is commonly used for cervical vertebral body lesions. However, the structure of blood vessels and nerve tissues along the route of anterior cervical surgery is complex. We aimed to measure the data of the longus colli, the sympathetic trunk and the cervical sympathetic trunk （CST） ganglia in Chinese cadaver speci- mens. A total of 32 adult cadavers were studied. We delineated the surgical anatomy of the CST. The superior and inferior/cervicothoracic ganglia of the sympathetic trunk consistently appeared. The middle ganglion was observed in 28.1% of the specimens and there were 2 cases of unilateral double middle cervical ganglia. The inferior ganglion was observed in 25.0% of the specimens and the cervicothoracic ganglion was observed in the remaining speci- mens. The distance between the CST gradually decreased from the top to the bottom, and the distance between the medial edges of the longus colli gradually broadened from the top down. The average angle between the bilat- eral CST and the midline of the vertebra was 11.2°± 1.8° on the left side and 10.3°± 1.4° on the right side. The average angle between the medial margins of longus colli of both sides was 11.1°± 1.9°. The CST is at high risk when LC muscle is cut transversely or is dragged heavily, especially at the levels of C6 and C7. Awareness of the regional anatomy of the CST could help surgeons to identify and preserve it during anterior cervical surgeries.

Effects of transection of cervical sympathetic trunk on cerebral infarct volume and oxygen free radical levels in rats with focal cerebral ischemia/reperfusion injury

BACKGROUND： Stellate ganglion block （SGB） plays a protective role on the brain, but the precise mechanism of action is not clear. OBJECTIVE： To simulate SGB by transection of the cervical sympathetic trunk （TCST） and to investigate the TCST effects on changes in cerebral infarct volume and oxygen free radical levels in rats with focal cerebral ischemia/reperfusion injury. DESIGN, TIME AND SETTING： A complete randomized control animal experiment was performed at the Institute of Neurological Diseases of Taihe Hospital, Yunyang Medical College from February to December 2005. MATERIALS： A total of 101 healthy Wistar rats, weighing 280-320 g, of both genders, aged 17-18 weeks, were used in this study. 2, 3, 5-triphenyltetrazolium chloride （TTC） was purchased from Changsha Hongyuan Biological Company. Superoxide dismutase （SOD）, malondialdehyde （MDA） and nitric oxide （NO） assay kits were provided by Nanjing Jiancheng Bioengineering Institute. METHODS： Rats were randomly divided into a TCST group, a model group and a sham operation group. Successful models were included in the final analysis, with at least 20 rats in each group. After TCST, rat models of focal cerebral ischemia/reperfusion injury were established in the TCST group by receiving middle cerebral artery occlusion （MCAO） by the intraluminal suture method for 2 hours, followed by 24 hours of reperfusion. Rat models of focal cerebral ischemia/reperfusion injury were made in the model group. Rats in the sham operation group underwent experimental procedures as for the model group, threading depth of 10 mm, and middle cerebral artery was not ligated. MAIN OUTCOME MEASURES： Brain tissue sections of ten rats from each group were used to measure cerebral infarct volume by TTC staining. Brain tissue homogenate of another ten rats from each group was used to detect SOD activities, MDA contents and NO levels. Rat neurological function was assessed by neurobehavioral measures. RESULTS： Cerebral infarct volume was bigger in the model group than in the TCST group （P 〈 0.05）. Twenty four hours after cerebral ischemia/reperfusion, SOD activities were lower, whereas MDA contents and NO levels were higher in the TCST and model groups, compared with the sham operation group （P 〈 0.05 or P 〈 0.01）. Compared with the model group, SOD activities were higher, whereas MDA contents and NO levels were lower in the TCST group （P 〈 0.05）. CONCLUSION： After TCST, cerebral infarct volume is reduced, SOD activities are increased, and MDA contents and NO levels are decreased compared to the model group in rats with focal cerebral ischemia/reperfusion injury. These changes may be associated with TCST.