Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, Vienna, Austria; Ludwig Boltzmann Institute for Cardiovascular Research, Vienna, Austria; Division of Anatomy, Center for Anatomy and Cell Biology, Medical University of Vienna, Vienna, Austria.
Division of Anatomy, Center for Anatomy and Cell Biology, Medical University of Vienna, Vienna, Austria.
Brain Stimul. 2024 May-Jun;17(3):510-524. doi: 10.1016/j.brs.2024.04.016. Epub 2024 Apr 25.
BACKGROUND: Electrical stimulation of the vagus nerve (VN) is a therapy for epilepsy, obesity, depression, and heart diseases. However, whole nerve stimulation leads to side effects. We examined the neuroanatomy of the mid-cervical segment of the human VN and its superior cardiac branch to gain insight into the side effects of VN stimulation and aid in developing targeted stimulation strategies. METHODS: Nerve specimens were harvested from eight human body donors, then subjected to immunofluorescence and semiautomated quantification to determine the signature, quantity, and spatial distribution of different axonal categories. RESULTS: The right and left cervical VN (cVN) contained a total of 25,489 ± 2781 and 23,286 ± 3164 fibers, respectively. Two-thirds of the fibers were unmyelinated and one-third were myelinated. About three-quarters of the fibers in the right and left cVN were sensory (73.9 ± 7.5 % versus 72.4 ± 5.6 %), while 13.2 ± 1.8 % versus 13.3 ± 3.0 % were special visceromotor and parasympathetic, and 13 ± 5.9 % versus 14.3 ± 4.0 % were sympathetic. Special visceromotor and parasympathetic fibers formed clusters. The superior cardiac branches comprised parasympathetic, vagal sensory, and sympathetic fibers with the left cardiac branch containing more sympathetic fibers than the right (62.7 ± 5.4 % versus 19.8 ± 13.3 %), and 50 % of the left branch contained sensory and sympathetic fibers only. CONCLUSION: The study indicates that selective stimulation of vagal sensory and motor fibers is possible. However, it also highlights the potential risk of activating sympathetic fibers in the superior cardiac branch, especially on the left side.
背景:刺激迷走神经(VN)是治疗癫痫、肥胖、抑郁和心脏病的一种方法。然而,整个神经刺激会导致副作用。我们检查了人类中颈段迷走神经及其心上神经分支的神经解剖结构,以深入了解 VN 刺激的副作用,并帮助开发靶向刺激策略。
方法:从 8 名人体供体中采集神经标本,然后进行免疫荧光和半自动定量分析,以确定不同轴突类别的特征、数量和空间分布。
结果:右侧和左侧颈迷走神经(cVN)分别包含 25489±2781 和 23286±3164 根纤维。三分之二的纤维是无髓鞘的,三分之一是有髓鞘的。右侧和左侧 cVN 中的大约四分之三的纤维是感觉纤维(73.9±7.5%对 72.4±5.6%),而 13.2±1.8%对 13.3±3.0%是特殊内脏运动和副交感神经纤维,13±5.9%对 14.3±4.0%是交感神经纤维。特殊内脏运动和副交感神经纤维形成簇。心上神经分支包含副交感、迷走感觉和交感神经纤维,左侧心上神经分支比右侧含有更多的交感神经纤维(62.7±5.4%对 19.8±13.3%),50%的左侧分支仅含有感觉和交感神经纤维。
结论:研究表明,选择性刺激迷走感觉和运动纤维是可能的。然而,它也突出了在高级心脏分支中激活交感神经纤维的潜在风险,尤其是在左侧。
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