Anatomic Variation of Rami Communicantes in the Upper Thoracic Sympathetic Chain: A Human Cadaveric Study

Area of Science:

• Anatomy
• Surgical Anatomy
• Thoracic Surgery

Background:

• Hyperhidrosis results from sympathetic nervous system overactivity.
• Surgical sympathectomy is a treatment option for refractory hyperhidrosis.
• Anatomical variations may impact surgical outcomes.

Purpose of the Study:

• Investigate anatomical variations in the upper thoracic sympathetic chain and rami communicantes.
• Determine the implications of these variations for hyperhidrosis surgery.

Main Methods:

• Dissection, measurement, and mapping of the upper 4 thoracic sympathetic ganglia, intercostal nerves, and rami communicantes in 20 cadavers (40 sides).
• Recorded ganglia location and analyzed incidence, orientation, and distance of rami communicantes.
• Compared variations across ganglionic levels and between sides.

Main Results:

• Stellate ganglions were present in 70% of specimens; Kuntz fibers in 40%.
• Rami communicantes incidence decreased from superior to inferior ganglia.
• Significantly more rami were identified on the right side (P=0.03), with greater horizontal distance (P=0.04).

Conclusions:

• Substantial anatomical variation exists in upper thoracic rami communicantes between sides.
• These variations necessitate careful consideration during surgical sympathectomy planning.
• Addressing anatomical variability may improve hyperhidrosis treatment outcomes and reduce recurrence.