Radiological evaluation of the localization of sympathetic ganglia in the cervical region

Abstract

Purpose: To determine local variations of cervical sympathetic ganglia (CSG) according to vertebral levels on preoperative neck magnetic resonance imaging (MRI) by designating carotid artery (CA) as the standard landmark at the center, in attempts to prevent injury to CSG in the anterior-anterolateral approaches performed in the cervical spinal region. Materials and Methods: The retrospective study reviewed neck MRI images of 281 patients, of which the images of 231 patients were excluded from the study based on the exclusion criteria. As a result, the MRI images of the remaining 50 patients were included in the study. The circumference of carotid artery (CA) was divided into eight equal zones with CA defined as the standard landmark at the center. High-risk zones were determined based on the anterior-anterolateral approaches. Results: At C1 level, a superior ganglion was located on the right side in 32 (64%) and on the left side in 30 (60%) patients. At this level, it was most commonly located in Zone 6. Middle ganglion was observed most frequently at C3 level, which was detected on the right side in 17 (34%) and on the left side in 17 (34%) patients. At this level, it was most commonly located in Zone 2. Conclusion: Variations in the localizations of superior and middle cervical ganglia should be taken into consideration prior to surgical procedures planned for this region. This study sheds light on high-risk zones in the surgical site and could guide surgeons to better understand the location of cervical sympathetic ganglia before surgical planning.