Bilateral Dorsal Sympathectomy for Hyperhidrosis

Morphological Spectra of Adult Human Stellate Ganglia: Implications for Thoracic Sympathetic Denervation

Cardiac sympathetic denervation (CSD) to treat ventricular arrhythmias (VAs) requires transection at the middle or lower third of stellate (cervicothoracic) ganglia (SG). However, the morphological appearance of the adult SG and distribution of neuronal somata within it are not well described. To determine the morphology of left and right SG (LSG and RSG) and the distribution of somata within. LSG and RSG (n = 28) from 14 embalmed adult cadavers were dissected intact. Weight, volume, height, morphologic appearance, relationship between C8 and T1 ganglia (which form the SG) were determined, along with histology. Demographics, history of cardiac disease, and cause of death were also reviewed. Mean age of the subjects was 76 ± 13 years, and 5/14 were male. Three distinct morphologies of SG were identified: fusiform-rounded; fusiform-elongated; and bilobed. RSG and LSG did not differ in weight or volume. RSG were longer than LSG (2.05 ± 0.28 cm vs. 1.66 ± 0.47 cm, P = 0.024). Bilobed morphology was most common in RSGs (8/14), while fused, elongated was most common in LSG (8/14). RSGs lacked fused, rounded appearance, while 28.6% of LSG appeared as such. Histologically, one focus of somata was seen in fused rounded ganglia, while fused elongated SG had somata distributed throughout. Bilobed SG demonstrated two foci of somata, with the interconnecting stalk containing sparse somata. SG appears in three major forms and contains varying distributions of somata. Larger studies are warranted to define the relationship between gross anatomy and distribution of neuronal somata to improve the efficacy of CSD in treating VAs. Anat Rec, 301:1244-1250, 2018. © 2018 Wiley Periodicals, Inc.