Department of Radiology, Namwon Medical Center, Republic of Korea; Department of Radiology, Chonnam National University Hospital, Republic of Korea.
Department of Radiology, CHA University College of Medicine, Gangnam CHA Hospital, Republic of Korea.
Pain Physician. 2018 Jan;21(1):9-18.
Understanding the characteristics of the middle cervical sympathetic ganglion (MCSG) may minimize procedure-related complications and maximize efficacy during surgery or ultrasound (US)-guided procedures. The location and detection rate of the MCSG were variable in small population studies. Therefore, a large population study or meta-analysis could give more information about the MCSG.
We aim to review the published literature and evaluate the anatomical features of the MCSG, including the detection rate, location, size, and a normal variation, and to review the clinical relevance of MCSG for procedures including, US-guided ganglion block, ethanol ablation (EA), or radiofrequency ablation (RFA).
A systematic review and meta-analysis. The Ovid-MEDLINE and EMBASE databases were searched to find the detection rate, location, and other characteristics of the MCSG.
The pooled proportions for the detection rate of the MCSG were assessed using the DerSimonian-Laird random-effects model.
Heterogeneity among the studies was determined using a chi-square analysis for the pooled estimates and inconsistency index (I²). In order to reduce the heterogeneity, sensitivity analyses were performed.
A review of 542 studies identified 8 eligible studies, with 273 MCSGs included in the meta-analysis. The pooled proportion for the detection rate of the MCSG was 50.4% (95% confidence interval [CI], 34.5 - 66.4%). Considerable heterogeneity among the studies was observed (I² = 94.9%). In the sensitivity analysis, when excluding one study, heterogeneity was reduced with a recalculated pooled proportion of 44.2% (95% CI, 32.1 - 56.2%; I² = 86.0%). The location of the MCSG is usually posterior to the carotid sheath and anterior to the longus colli muscle at the level of the C3 - C7 vertebrae. There was a variant where the cervical sympathetic trunk was located at the posterior wall of the carotid sheath and was adherent to the sheath. The size of the MCSG is as follows: the width, length, and height ranges were 3.8 - 6.3 mm, 6.3 - 10.5 mm, and 1.7 - 2.1 mm, respectively. A specific type of MCSG, referred to as the "double middle cervical ganglion", consisting of 2 ganglia, was demonstrated in 3 studies with a detection rate of 2.9 - 10%.
This meta-analysis included a relatively small number of studies. Significant heterogeneity was also present in the detection rate of MCSG in these studies. There was a lack of concentrated information about the MCSG, because the majority of the included studies focused on the entire cervical sympathetic chain, not only MCSG primarily. Improving complication rates might be limited due to the approximate 50% detection rate.
Understanding the characteristics and variations of the MCSG could minimize complications and maximize efficacy during surgery and US-guided procedures.
Middle cervical sympathetic ganglion, cervical sympathetic trunk, cervical sympathetic chain, ultrasound, nerve block, ethanol ablation, radiofrequency ablation, thyroid, Horner syndrome, meta-analysis.
了解颈中交感神经节（MCSG）的特征可以最大限度地减少手术或超声（US）引导程序相关的并发症，并提高疗效。在小人群研究中，MCSG 的位置和检测率存在差异。因此，大人群研究或荟萃分析可以提供更多关于 MCSG 的信息。
我们旨在回顾已发表的文献，评估 MCSG 的解剖学特征，包括检测率、位置、大小和正常变异，并回顾 MCSG 对于包括 US 引导下神经节阻滞、乙醇消融（EA）或射频消融（RFA）在内的程序的临床相关性。
系统回顾和荟萃分析。在 Ovid-MEDLINE 和 EMBASE 数据库中搜索 MCSG 的检测率、位置和其他特征的文献。
使用 DerSimonian-Laird 随机效应模型评估 MCSG 检测率的汇总比例。
使用 pooled estimates 和不一致指数（I²）的卡方分析来确定研究之间的异质性。为了减少异质性，进行了敏感性分析。
对 542 项研究进行了综述，确定了 8 项符合条件的研究，其中 273 个 MCSG 纳入荟萃分析。MCSG 的检测率汇总比例为 50.4%（95%置信区间[CI]：34.5%至 66.4%）。研究之间存在显著异质性（I²=94.9%）。在敏感性分析中，当排除一项研究时，异质性降低，重新计算的汇总比例为 44.2%（95%CI：32.1%至 56.2%；I²=86.0%）。MCSG 的位置通常位于颈动脉鞘的后部和头长肌的前部，在 C3-C7 椎体水平。有一种变异，颈交感干位于颈动脉鞘的后壁，与鞘粘连。MCSG 的大小如下：宽度、长度和高度范围分别为 3.8-6.3mm、6.3-10.5mm 和 1.7-2.1mm。在 3 项研究中，观察到一种称为“双颈中交感神经节”的特定类型的 MCSG，其检测率为 2.9%至 10%，由 2 个神经节组成。
本荟萃分析纳入的研究数量相对较少。这些研究中 MCSG 的检测率也存在显著异质性。由于大多数纳入的研究主要关注整个颈交感神经链，而不仅仅是 MCSG，因此关于 MCSG 的集中信息有限。由于检测率约为 50%，因此可能会限制并发症发生率的提高。
了解 MCSG 的特征和变异可以最大限度地减少手术和 US 引导程序相关的并发症，并提高疗效。
颈中交感神经节、颈交感干、颈交感神经链、超声、神经阻滞、乙醇消融、射频消融、甲状腺、霍纳综合征、荟萃分析。
