Stellate ganglion


The stellate ganglion is a sympathetic ganglion formed by the fusion of the inferior cervical ganglion and the first thoracic ganglion, which exists in 80% of cases. Sometimes the second and the third thoracic ganglia are included in this fusion. Stellate ganglion is relatively big compared to much smaller thoracic, lumbar and sacral ganglia and it is polygonal in shape. Stellate ganglion is located at the level of C7, anterior to the transverse process of C7 and the neck of the first rib, superior to the cervical pleura and just below the subclavian artery. It is superiorly covered by the prevertebral lamina of the cervical fascia and anteriorly in relation with common carotid artery, subclavian artery and the beginning of vertebral artery which sometimes leaves a groove at the apex of this ganglion.
Relations of the apex of the stellate ganglion:
The stellate ganglia may be cut in order to decrease the symptoms exhibited by Raynaud's phenomenon and hyperhydrosis of the hands. Injection of local anesthetics near the stellate ganglion can sometimes mitigate the symptoms of sympathetically mediated pain such as complex regional pain syndrome type I, and PTSD. Injection is often given near the Chassaignac's Tubercle due to this being an important landmark lateral to the cricoid cartilage. It is thought that anesthetic is spread along the paravertebral muscles to the stellate ganglion.
Stellate ganglion block also shows great potential as a means of reducing the number of hot flushes and night awakenings suffered by breast cancer survivors and women experiencing extreme menopause. The Stellate Ganglion
Blocks done by the military in Veteran with CRPS had an interesting side effect, a large percentage of veterans with PTSD had Spontaneous Elimination of PTSG. This has led it to be called "The God Block" This has led to 200 million dollar study in the VA to study this further. Nerve fibers from the Stellate Ganglion go up the superior cervical sympathetic chain and into the Pterygopalatine Ganglion SPG blocks have been shown to reduce anxiety, headaches, migraines, cancer pain and other disorders.
Self-administration of SPG blocks is another method of delivering sphenopalatine blockade and indirect stellate ganglion blockade.
Complications associated with a stellate ganglion block include Horner's syndrome, accidental intra-arterial or intravenous injection, difficulty swallowing, vocal cord paralysis, epidural spread of local anaesthetic, and pneumothorax.
Blunt needling of the stellate ganglion with an acupuncture needle is used in traditional Chinese medicine to decrease sympathetically mediated symptoms as well.
Block of the stellate ganglion has also been explored in coronary artery bypass surgery, as well as posttraumatic stress disorder.
Left stellectomy is a treatment strategy in prolonged QT syndrome because activity of the stellate ganglia drives prolonged QT. However, this therapy is only offered to patients who are already on a beta blocker and experience frequent shocks from an implantable cardioverter-defibrillator, because stellectomy causes Horner's syndrome.

Anatomy

The stellate ganglion lies in front of the neck of the first rib. The vertebral artery lies anterior to the ganglion as it has just originated from the subclavian artery. After passing over the ganglion, the artery enters the vertebral foramen and lies posterior to the anterior tubercle of C6.