4th Ganglia Research Articles

Topographical considerations under video-scope guidance in the T3,4 levels sympathetic surgery

Anatomical variation of the sympathetic nervous system is known to be one of the main causes of failure and dissatisfaction after sympathetic surgery. However, there are only few reports on the descriptive analysis of sympathetic nerve variants. The purpose of this study is to investigate the anatomical variations of the sympathetic trunk at the levels of T3 and T4 ganglia considered in a topographic approach for sympathetic procedures and to further improve the postoperative outcome. From June 2003 to January 2004, 44 patients with palmar hyperhidrosis underwent bilateral T3,4 ramicotomy via video-assisted thoracoscopic surgery. The anatomy of T3 and T4 sympathetic ganglia, pathway of sympathetic trunk, and rami-communicantes were recorded on video and still cut images for descriptive analysis. The thoracic sympathetic trunks were mostly lying against the heads of the ribs, but there were variants of sympathetic trunk running along the medial side of the rib heads of 3rd, 4th and 5th ribs, respectively in 9.0%, 18.0% and 37.5% of the cases. There were also variants running along the lateral side of rib heads near the neck portion in 12.5%, 10.2% and 8.0% of the cases. The 3rd ganglion was located within the intercostal space (59.1%) or at the level of the upper border of the 4th rib (36.4%) or upon the 4th rib (4.5%). The location of the 4th ganglion was in the intercostal space (18.2%), the upper border of the 5th rib (44.3%) or upon the 5th rib (37.5%). The ascending rami were found at the level of the 3rd ganglion in 48.8% and the 4th ganglion in 45.5% of the cases. The descending rami were located at the level of 3rd and the 4th ganglion in 8.0% and 6.8%, respectively. And the middle rami were found in all cases except one. It may be difficult to localize the sympathetic trunk in some cases of severe obesity; a careful inspection has to be performed from the medial side of the rib heads to the neck portion. The obvious 'downward shift of ganglion' in the position shown as the thoracic sympathetic trunk descends is to be deliberated in T4 sympathetic surgery. Many ascending and descending accessory pathways of sympathetic nerve were observed; therefore, a lateral extension of electrocoagulation at the level of upper and lower rib border is necessary to impose a complete blockage of sympathetic nerve stimulus.

Thoracoscopic Upper Thoracic Sympathectomy for Upper Limb Hyperhidrosis

Objectives: To present a 30-month experience in thoracoscopic upper thoracic sympathectomy (TUTS) in Kuwait in 20 patients with upper limb hyperhidrosis (ULH). Methods: We performed 40 TUTSs in 20 patients with bilateral ULH. The T2–4 or T2–5 sympathetic ganglia were resected in 36 cases. Only the T2–3 ganglia were resected in 4 cases due to difficult localization of the 4th ganglion. Both sides were performed simultaneously. Chest tube drainage was performed at the end of each procedure. Results: The male:female ratio was 9:1, ranging in age from 13 to 43 years (mean age 26.95 years). Two patients had bilateral dense pleural adhesions, but the procedure was successful. Most patients were discharged on the 2nd postoperative day. Follow-up at 5–30 months (mean 16.3 months) was excellent both for immediate and permanent relief of ULH. Eleven of the 15 patients with pedal hyperhidrosis also had dry feet. Two patients developed transient Horner’s eye syndrome. One patient had persistent right pneumothorax that required chest tube drainage for 7 days. Four patients developed compensatory hyperhidrosis of the trunk and upper thighs. Fifteen patients (75%) expressed complete satisfaction. Five patients (25%) reported return of some moisture to their hands and axillae. Conclusion: TUTS is minimally invasive, feasible and effective. It has a low complication rate. We recommend this procedure as the method of choice for the management of ULH.

Central afferent pathways of long hair sensilla in the ventral nerve cord of the Indian black scorpion, Heterometrus fulvipes Koch

Histological and electrophysiological studies of identified long hair sensilla (LHS) have provided information on primary afferent fibre pathways in the ventral nerve cord of the Indian black scorpion, Heterometrus fulvipes. Cobalt-filling of single LHS on the metasoma showed that sensory axons enter the respective segmental ganglion, ascend ipsilaterally through the next anterior ganglia and terminate in a 4th ganglion. In each ganglion, these plurisegmental fibres give off collateral branches that terminate in the ganglionic neuropil. Fibres entering heterolateral connectives were not found. Recordings from peripheral nerves after deflections of a hair showed single or multiple spike discharges. A single spike could be recorded from ipsilateral anterior connectives of the ventral nerve cord, indicating a through-conductance of the sensory pathways. Strong deflections of a single hair activated several ipsilateral and fewer contralateral ascending interneurons and some segmentai motor neurons. Behavioral studies demonstrate the mechanoreceptive function of the LHS. The present study provides evidence in support of the notion that sensory afferents of the postabdomen in the scorpion bring about rapid, co-ordinated intersegmental movements of the multisegmented tail of the scorpion.

Abdominal nerves of the mature larva of castor silk moth, philosamia ricini hutt. (Lepidoptera: Saturniidae)

Of the 8 abdominal ganglia, Ist to 6th are similar in shape and location, whereas the 7th is incompletely fused with the terminal ganglion. The interganglionic connectives are fused with each other but a median line shows their separate identity. The connectives are the shortest between the 3rd thoracic and the 1st abdominal, and between the 6th and 7th abdominal ganglia. The pattern of nerve supply is more or less similar in the 3rd, 4th and 5th ganglia, and the nerves of the 4th ganglion are considered typical. With the exception of the 7th and 8th ganglia, each gives off 3 pairs of lateral nerves, viz., transverse, dorsal and ventral, innervating dorsal and spiracular regions, dorsal and laterodorsal regions, and ventral and ventrolateral regions respectively. Union of the transverse nerve with dorsal nerve at certain points is noted in 1st, 2nd and 4th ganglia, whereas ventral nerve joins with the transverse nerve of the following segment in the 1st, 2nd, 3rd and 7th ganglia. A plexus between the transverse and dorsal nerves of the 4th, 5th and 6th abdominal ganglia is formed near their origin from the ganglia. The 7th and 8th abdominal ganglia are placed in the 7th abdominal segment, and so the nerves of the 8th abdominal ganglion travel from 7th segment to the 8th segment. The 8th or terminal ganglion gives off a pair of transverse, dorsal and fused nerves. Few branches of the dorsal nerve innervate the areas to be innervated by the ventral nerve, which is lacking in 8th abdominal ganglion. The fused nerve innervates a part of the 8th, 9th and 10th abdominal segments.