School of Medicine, Department of Human Anatomy, First Unit, Cardiovascular Anatomy Lab, Buenos Aires University, Buenos Aires, Argentina.
School of Medicine, Department of Pathology, Institute of Cardiovascular Physiopathology (INFICA), Buenos Aires University, Buenos Aires, Argentina.
Clin Anat. 2024 Nov;37(8):886-899. doi: 10.1002/ca.24149. Epub 2024 Mar 12.
Current advances in the management of the autonomic nervous system in various cardiovascular diseases, and in treatments for pain or sympathetic disturbances in the head, neck, or upper limbs, necessitate a thorough understanding of the anatomy of the cervicothoracic sympathetic trunk. Our objective was to enhance our understanding of the origin and distribution of communicating branches and visceral cervicothoracic sympathetic nerves in human fetuses. This was achieved through a comprehensive topographic systematization of the branching patterns observed in the cervical and upper thoracic ganglia, along with the distribution of communicating branches to each cervical spinal nerve. We conducted detailed sub-macroscopic dissections of the cervical and thoracic regions in 20 human fetuses (40 sides). The superior and cervicothoracic ganglia were identified as the cervical sympathetic ganglia that provided the most communicating branches on both sides. The middle and accessory cervical ganglia contributed the fewest branches, with no significant differences between the right and left sides. The cervicothoracic ganglion supplied sympathetic branches to the greatest number of spinal nerves, spanning from C to T. The distribution of communicating branches to spinal nerves was non-uniform. Notably, C, C, and C received the fewest branches, and more than half of the specimens showed no sympathetic connections. C and C received sympathetic connections exclusively from the superior ganglion. Spinal nerves that received more branches often did so from multiple ganglia. The vertebral nerve provided deep communicating branches primarily to C, with lesser contributions to C, C, and C. The vagus nerve stood out as the cranial nerve with the most direct sympathetic connections. The autonomic branching pattern and connections of the cervicothoracic sympathetic trunk are significantly variable in the fetus. A comprehensive understanding of the anatomy of the cervical and upper thoracic sympathetic trunk and its branches is valuable during autonomic interventions and neuromodulation. This knowledge is particularly relevant for addressing various autonomic cardiac diseases and for treating pain and vascular dysfunction in the head, neck, and upper limbs.
当前，在各种心血管疾病的自主神经系统管理以及头颈部或上肢疼痛或交感神经紊乱的治疗方面取得了进展，这使得我们需要深入了解颈胸交感干的解剖结构。我们的目标是增强对人类胎儿交感神经交通支和内脏颈胸神经起源和分布的理解。为此，我们对颈胸神经节的分支模式以及交通支与每个颈脊神经的分布进行了全面的拓扑分类。我们对 20 个人类胎儿（40 侧）的颈胸部进行了详细的亚宏观解剖。上颈胸神经节和颈交感神经节被确定为双侧提供最多交通支的颈交感神经节。中颈和副颈神经节提供的分支最少，左右两侧无显著差异。颈胸神经节向最多数量的脊神经供应交感神经支，范围从 C 到 T。交通支向脊神经的分布不均匀。值得注意的是，C、C 和 C 接收的分支最少，超过一半的标本没有交感神经联系。C 和 C 仅接受来自上神经节的交感神经联系。接收更多分支的脊神经通常来自多个神经节。椎神经主要向 C 提供深部交通支，对 C、C 和 C 的贡献较小。迷走神经是与交感神经联系最直接的颅神经。胎儿颈胸交感干的自主分支模式和连接存在显著的变异性。全面了解颈胸交感干及其分支的解剖结构对于自主神经干预和神经调节非常重要。这种知识对于治疗各种自主心脏疾病以及头颈部和上肢的疼痛和血管功能障碍尤为重要。
