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Anatomical location of T2-3 sympathetic trunk and Kuntz nerve determined by transthoracic endoscopy.

AbstractOBJECT:
Bilateral subaxillary transthoracic endoscopic sympathectomy (TES) is a popular procedure of upper thoracic sympathectomy. The anatomical locations of the T-2 and T-3 sympathetic trunks, as viewed under the endoscope, are varied in the rib head areas. In this study, the authors investigated the more visible anatomical locations of the T-2 and T-3 sympathetic trunks, the so-called nerves of Kuntz, and intercostal rami by performing transthoracic endoscopy.
METHODS:
Seventy patients with palmar hyperhidrosis undergoing bilateral TES (140 sides) via the anterior subaxillary approach were included in this study. The operative findings and video images of the T-2 and T-3 sympathetic trunks and ganglia were recorded and analyzed. The anatomical locations of the T-2 and T-3 sympathetic trunks along the horizontal axes of the rib heads were determined using a three-region system constructed by the authors. The area between the rib neck and the medial border of the rib head was equally divided into Region E (external half) and Region M (medial half). The area between the medial border of the rib head and the paravertebral ligament was defined as Region I. The incidence of the T-2 and T-3 sympathetic trunks found in Regions E, M, and I were 31.4 to 42.9%, 50 to 57.1%, and 7.1 to 11.4%, respectively, on the left side, and 24.3 to 34.3%, 57.1 to 65.7%, and 8.6 to 10%, respectively, on the right side. One right (1.4%) and six left (8.6%) Kuntz nerves originating from the T-3 sympathetic trunk were found in seven patients (10%). The intercostal ramus was found around the T-2 rib neck in 24 patients (34.3%), with 18 cases (25.7%) for each side. The intercostal ramus around the T-3 rib neck was found in 17 patients (24.3%): 12 (17.1%) on the right and nine (12.9%) on the left.
CONCLUSIONS:
These results indicate that approximately 90% of the T-2 or T-3 sympathetic trunks are located on the rib head. These findings may also be used to assist the surgeon in fluoroscopic guidance for locating the T-2 and T-3 sympathetic trunks during posterior percutaneous sympathectomy.
AuthorsYeou-Chih Wang, Ming-Hsi Sun, Chi-Wen Lin, Yen-Ju Chen
JournalJournal of neurosurgery (J Neurosurg) Vol. 96 Issue 1 Suppl Pg. 68-72 (Jan 2002) ISSN: 0022-3085 [Print] United States
PMID11795717 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)
Topics
  • Adolescent
  • Adult
  • Child
  • Female
  • Humans
  • Hyperhidrosis (pathology, surgery)
  • Male
  • Middle Aged
  • Sympathectomy (methods)
  • Sympathetic Nervous System (pathology, surgery)
  • Thoracic Vertebrae (pathology, surgery)
  • Thoracoscopy (methods)

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