The stellate ganglion (or cervicothoracic ganglion) is a

sympathetic ganglion The sympathetic ganglia, or paravertebral ganglia, are autonomic ganglia of the sympathetic nervous system. Ganglia are 20,000 to 30,000 afferent and efferent nerve cell bodies that run along on either side of the spinal cord. Afferent nerve cel ...

formed by the fusion of the

inferior cervical ganglion The inferior cervical ganglion is one of the three cervical sympathetic ganglia (i.e. of the cervical portion of the sympathetic trunk). It is situated between the base of the transverse process of the last cervical vertebra and the neck of the ...

and the first thoracic (superior thoracic sympathetic)

ganglion A ganglion (: ganglia) is a group of neuron cell bodies in the peripheral nervous system. In the somatic nervous system, this includes dorsal root ganglia and trigeminal ganglia among a few others. In the autonomic nervous system, there are ...

, 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 (). It is relatively big compared to the much smaller thoracic, lumbar, and sacral ganglia.

Relations

Stellate ganglion is located at the level of C7, anterior to the

transverse process Each vertebra (: vertebrae) is an irregular bone with a complex structure composed of bone and some hyaline cartilage, that make up the vertebral column or spine, of vertebrates. The proportions of the vertebrae differ according to their spina ...

of C7 and the neck of the

first rib The rib cage or thoracic cage is an endoskeletal enclosure in the thorax of most vertebrates that comprises the ribs, vertebral column and sternum, which protect the vital organs of the thoracic cavity, such as the heart, lungs and great vessel ...

, superior to the cervical pleura and just below the

subclavian artery In human anatomy, the subclavian arteries are paired major arteries of the upper thorax, below the clavicle. They receive blood from the aortic arch. The left subclavian artery supplies blood to the left arm and the right subclavian artery suppli ...

. It is superiorly covered by the prevertebral lamina of the cervical fascia and anteriorly in relation with

common carotid artery In anatomy, the left and right common carotid arteries (carotids) () are artery, arteries that supply the head and neck with oxygenated blood; they divide in the neck to form the external carotid artery, external and internal carotid artery, inte ...

, subclavian artery and the beginning of

vertebral artery The vertebral arteries are major artery, arteries of the neck. Typically, the vertebral arteries originate from the subclavian arteries. Each vessel courses superiorly along each side of the neck, merging within the skull to form the single, m ...

which sometimes leaves a groove at the apex of this ganglion (this groove can sometimes even separate the stellate ganglion into so called vertebral ganglion). Relations of the apex of the stellate ganglion: * covered by the

endothoracic fascia The endothoracic fascia is the layer of loose connective tissue deep to the intercostal spaces and ribs, separating these structures from the underlying pleura. This fascial layer is the outermost membrane of the thoracic cavity. The endothoraci ...

and

parietal pleura The pleurae (: pleura) are the two flattened closed sacs filled with pleural fluid, each ensheathing each lung and lining their surrounding tissues, locally appearing as two opposing layers of serous membrane separating the lungs from the medi ...

* 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 Raynaud syndrome, also known as Raynaud's phenomenon, is a medical condition in which the spasm of small arteries causes episodes of reduced blood flow to end arterioles. Typically the fingers, and, less commonly, the toes, are involved. Rare ...

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 Complex regional pain syndrome (CRPS type 1 and type 2), sometimes referred to by the hyponyms reflex sympathetic dystrophy (RSD) or reflex neurovascular dystrophy (RND), is a rare and severe form of neuroinflammatory and dysautonomic disorder ...

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 In tetrapods, cervical vertebrae (: vertebra) are the vertebrae of the neck, immediately below the skull. Truncal vertebrae (divided into thoracic and lumbar vertebrae in mammals) lie caudal (toward the tail) of cervical vertebrae. In sauropsid s ...

(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 Breast cancer is a cancer that develops from breast tissue. Signs of breast cancer may include a Breast lump, lump in the breast, a change in breast shape, dimpling of the skin, Milk-rejection sign, milk rejection, fluid coming from the nipp ...

survivors and women experiencing severe symptoms of menopause. 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. 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. Self-administration of SPG blocks (SASPGB) is another method of delivering sphenopalatine blockade and indirect stellate ganglion blockade. Complications associated with a stellate ganglion block include

Horner's syndrome Horner's syndrome, also known as oculosympathetic paresis, is a combination of symptoms that arises when a group of nerves known as the sympathetic trunk is damaged. The signs and symptoms occur on the same side (ipsilateral) as it is a lesion ...

, accidental intra-arterial or intravenous injection,

difficulty swallowing Dysphagia is difficulty in swallowing. Although classified under " symptoms and signs" in ICD-10, in some contexts it is classified as a condition in its own right. It may be a sensation that suggests difficulty in the passage of solids or li ...

vocal cord In humans, the vocal cords, also known as vocal folds, are folds of throat tissues that are key in creating sounds through vocalization. The length of the vocal cords affects the pitch of voice, similar to a violin string. Open when breathing a ...

paralysis,

epidural Epidural administration (from Ancient Greek ἐπί, "upon" + '' dura mater'') is a method of medication administration in which a medicine is injected into the epidural space around the spinal cord. The epidural route is used by physicians ...

spread of

local anaesthetic A local anesthetic (LA) is a medication that causes absence of all sense, sensation (including pain) in a specific body part without loss of consciousness, providing local anesthesia, as opposed to a general anesthetic, which eliminates all sen ...

, and

pneumothorax A pneumothorax is collection of air in the pleural space between the lung and the chest wall. Symptoms typically include sudden onset of sharp, one-sided chest pain and dyspnea, shortness of breath. In a minority of cases, a one-way valve is ...

. Block of the stellate ganglion has also been explored in

coronary artery bypass surgery Coronary artery bypass surgery, also known as coronary artery bypass graft (CABG, pronounced "cabbage"), is a surgical procedure to treat coronary artery disease (CAD), the buildup of plaques in the arteries of the heart. It can relieve chest ...

, as well as

posttraumatic stress disorder Post-traumatic stress disorder (PTSD) is a mental disorder that develops from experiencing a Psychological trauma, traumatic event, such as sexual assault, domestic violence, child abuse, warfare and its associated traumas, natural disaster ...

. There are current investigations into stellate ganglion block for those suffering from altered sense of smell and taste due to COVID-19 infection. 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 An implantable cardioverter-defibrillator (ICD) or automated implantable cardioverter defibrillator (AICD) is a device implantable inside the body, able to perform defibrillation, and depending on the type, cardioversion and pacing of the h ...

(ICD), because stellectomy causes Horner's syndrome. Stellate ganglion nerve block can also be used as a treatment for refractory ventricular tachycardia.

Anatomy

The stellate ganglion lies in front of the neck of the first

rib In vertebrate anatomy, ribs () are the long curved bones which form the rib cage, part of the axial skeleton. In most tetrapods, ribs surround the thoracic cavity, enabling the lungs to expand and thus facilitate breathing by expanding the ...

, and posterior to the

. The

lies anterior to the ganglion as it has just originated from the

. After passing over the ganglion, the artery enters the

vertebral foramen In a typical vertebra, the vertebral foramen is the foramen (opening) of a vertebra bounded ventrally/anteriorly by the body of the vertebra, and the dorsally/posteriorly by the vertebral arch. In the articulated spine, the successive vertebral ...

and lies posterior to the anterior tubercle of C6 (

).Raj, Practical Management of Pain, 3rd ed, pp656-657

References

{{Authority control Sympathetic ganglia