The stellate ganglion (or cervicothoracic ganglion[1]) is a sympathetic ganglion formed by the fusion of the inferior cervical ganglion and the first thoracic (superior thoracic sympathetic) ganglion,[2] which is present in 80% of individuals. Sometimes, the second and the third thoracic ganglia are included in this fusion.
Anatomy
The stellate ganglion is polygonal in shape (Latin: stellatum, lit. 'star-shaped'). It is relatively big (10–12 × 8–20 mm) compared to the much smaller thoracic, lumbar, and sacral ganglia.
right stellate ganglion is in relation with right brachiocephalic vein anteriorly
right stellate ganglion is in relation with sternal part of subclavian artery anteriorly
laterally: first intercostal artery
medially: longus colli muscle
Clinical significance
The stellate ganglia may be cut in order to decrease the symptoms exhibited by Raynaud's phenomenon and hyperhydrosis (extreme sweating) 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 (reflex sympathetic dystrophy), and symptoms associated with alterations in arousal and reactivity (Criterion E) of PTSD. Injection is often given near the Chassaignac's tubercle (anterior tubercle of transverse process of C6) 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 flashes and night awakenings suffered by breast cancer survivors and women experiencing severe symptoms of menopause.[3]
There has been interest in using stellate ganglion blocks to treat PTSD, particularly in combat veterans. A 2017 review of the evidence from the VA Evidence-based Synthesis Program found that while the procedure had been reported as effective in unblinded case series, the evidence from randomized controlled trials remained inconclusive.[4]
Nerve fibers from the stellate ganglion go up the superior cervical sympathetic chain and into the pterygopalatine (sphenopalatine) ganglion (SPG). SPG blocks have been shown to reduce anxiety, headaches, migraines, cancer pain and other disorders.[5]
Self-administration of SPG blocks (SASPGB) is another method of delivering sphenopalatine blockade and indirect stellate ganglion blockade.
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 (ICD), because stellectomy causes Horner's syndrome.
Stellate ganglion nerve block can also be used as a treatment for refractory ventricular tachycardia.[8]
^Shapira, Ira L. (11 April 2019). "Neuromuscular dentistry and the role of the autonomic nervous system: Sphenopalatine ganglion blocks and neuromodulation. An International College of Cranio Mandibular Orthopedics (ICCMO) position paper". Cranio. 37 (3): 201–206. doi:10.1080/08869634.2019.1592807. PMID30973097. S2CID108295446.
^Yildirim V, Akay HT, Bingol H, et al. (2007). "Pre-emptive stellate ganglion block increases the patency of radial artery grafts in coronary artery bypass surgery". Acta Anaesthesiologica Scandinavica. 51 (4): 434–40. doi:10.1111/j.1399-6576.2006.01260.x. PMID17378781. S2CID28530232.