Abstract
Lesions of the cervicothoracic ganglion (CTG) result in interruption of sympathetic fibers
to the head, neck, upper limb, and thoracic viscera. The accurate understanding of the
anatomy of the CTG is relevant to sympathectomy procedures that may be prescribed in
cases where conventional intervention has failed. This study documents the incidence and
distribution of the CTG to avoid potential complications such as Horner’s syndrome and
cardiac arrhythmias. This study utilized 48 cadavers, in which a total of 89 sympathetic
chains were dissected. The inferior cervical ganglion (ICG) and the first thoracic ganglion
was fused in 75 cases (84.3%) to form the CTG. It was present bilaterally in 48 of these
specimens (65.3%). Three different shapes of CTG were differentiated, viz. spindle, dumbbell,
and an inverted ‘‘L’’ shape. The dumbbell and inverted ‘‘L’’ shapes demonstrated a
definite ‘‘waist’’ (i.e., a macroscopically visible union of the ICG and T1 components of
the CTG). Rami from the CTG was distributed to the brachial plexus, the subclavian and
vertebral arteries, the brachiocephalic trunk, and the cardiac plexus. This study demonstrates
a high incidence of a double cardiac sympathetic nerve arising from CTG. It is
therefore imperative that in the technique of sympathectomy, for intractable anginal pain, the
surgeon excises both these rami but does not destroy the ganglion itself. The ever-improving
technology in endoscopic surgery has made investigations into the nuances of the anatomy of
the sympathetic chain essential. Clin. Anat. 19:323–326, 2006.