Malignant peripheral nerve sheath tumor of the parapharyngeal space arising from cervical sympathetic chain: A rare entity

Malignant peripheral nerve sheath tumors (MPNSTs) of parapharyngeal space are rare and if present are most often in association with neurofibromatosis type 1 (NF-1). Only a few cases of MPNST have been reported in the literature without coexisting NF. We report one such case of an MPNST of parapharyngeal space tumor in a 35-year-old female with no associated features of NF-1. She presented with right-sided neck swelling and ptosis. Magnetic resonance imaging showed a 7 cm × 8 cm × 11 cm irregular swelling in the right parapharyngeal space with invasion of surrounding muscles. The mass was excised using a transcervical approach. Postoperative histopathological examination of the specimen revealed MPNST possibly arising from the cervical sympathetic chain

Cervical Sympathetic Chain Schwannoma Mimicking Carotid Body Tumor / 대한이비인후과학회지

Schwannoma arising from cervical sympathetic chain is relatively uncommon and can be occasionally misdiagnosed as carotid body tumor. On MR images, schwannoma shows generally hypointense features on the T1-weighted images and hyperintense features on the T2-weighted images. Occasionally, however, contrast administration, which lets schwannoma show marked enhancement, may make it difficult to differentiate schwannoma from carotid body tumor. A 41-year-old woman presented a neck mass on the left. MR images of the neck and carotid angiography revealed a well-enhancing ovoid tumor, which separated the internal carptod arteries from the external carotid arteries at the level of carotid bifurcation. Complete tumor resection was performed and histopathology findings confirmed a schwannoma originating from the sympathetic chain. Postoperatively, miosis and facial anhydrosis of the left side were noted without ptosis, enophthalmos or other neurologic deficits. We report this case with a review of the literatures.

Application of special life quality scale in effect evaluation of T2～4 transection of sympathetic chain to treat hyperidrosis of hand and foot / 中国实用护理杂志

Objective To evaluate the value of the specific quality of life scale in effect evaluation of T2～4 transection of sympathetic chain to treat hyperidrosis of hand and foot. Methods 125 patients with hyperidrosis of hand and foot who had accepted operation in our department were retrospectively analyzed. These patients were evaluated with the specific QOL scale. The degree of satisfaction, days of stay,time of operation and complications were also recorded. The difference of life quality score was also compared and underwent correlation analysis. Results An obvious improvement of QOL was observed after operation. The same tend could be observed in the degree of satisfaction with the operation. The operation had been proved to be safe and effective. Few serious complication were reported. The alleviation of QOL and compensatory hyperhidrosis dominated the result of degree of satisfaction. Conclusions Operation can improve quality of life of hyperhidrosis patients greatly. The specific QOL questionnaire of hyperhidrosis has a bright future in clinical practice.

Ancient Schwannoma of the cervical sympathetic chain: A case report

Schwannoma of the cervical sympathetic chain is an extremely rare nerve tumour. We report an unusual swelling in a 41-year-old female who presented with an asymptomatic solitary mass in the right parapharyngeal space. Clinical examination and computed tomography showed displaced carotid artery in an antero-medial direction. Surgical excision of the lesion was carried out and histological examination revealed an Ancient Schwannoma.

Variations of Thoracic Splanchnic Nerves and its Clinical Implications / Variaciones de los Nervios Esplácnicos Torácicos y sus Implicancias Clínicas

The present study reports an anomalous branching pattern of the thoracic sympathetic chain. At the level of T3 ganglion, an anomalous branch i.e accessory sympathetic chain (ASC) descended anteromedial to the main sympathetic chain (MSC). The MSC and the ASC communicated with each other at the level of T9, T10 and T11 ganglion, indicating the absence of classical pattern of greater, lesser and least splanchnic nerves on the right side. However, on the left side, the sympathetic chain displayed normal branching pattern. We opine that the ASC may be representing a higher origin of greater splanchnic nerve at the level of T3 ganglion and the branches from MSC at T9, T10 and T11 ganglion may be the lesser and least splanchnic nerves, which further joined the ASC (i.e presumably the greater splanchnic nerve) to form a common trunk. This common trunk pierced the right crus of diaphragm to reach the right suprarenal plexus after giving few branches to the celiac plexus. Awareness and knowledge of such anatomical variants of thoracic sympathetic chain may be helpful to surgeons in avoiding any incomplete denervation or preventing any inadvertent injury during thoracic sympathectomy.

El presente estudio relata un patrón de ramos anómalos de la cadena simpática torácica. A nivel del ganglio de T3, un ramo anómalo denominado cadena simpática accesoria (CSA), descendió anteroedialmente a la cadena simpática principal (CSP). La CSP y la CSA comunicadas cada una con la otra a nivel de los ganglios de T9, T10 y T11, indicaban la ausencia de patrones clásicos de nervios esplácnicos mayor, menor y mínimo del lado derecho. Sin embargo, en el lado izquierdo, la cadena simpática estaba dispuesta en un de patrón normal. Nuestra opinión es que la CSA estaría representando un origen alto del nervio esplácnico mayor a nivel del ganglio de T3 y que los ramos de CSP de los ganglios T9, T10 y T11 podrían ser los nervios esplácnicos menor y mínimo, los cuales se unían lejos a la CSA (presumiblemente el nervio esplácnico mayor) para formar un tronco común. Este tronco común perforaba la cruz derecha del diafragma para alcanzar el plexo suprarrenal derecho, dando después pequeños ramos para el plexo celiaco. El conocimiento de tales variaciones de la cadena simpática torácica pueden ser de ayuda para los cirujanos, pudiendo ser evitada alguna denervación incompleta o prevenir algún daño involuntario durante la simpactectomía torácica.

The Effects of Propofol on Blood-Brain Barrier Disruption with Mannitol Infusion in Cervical Sympathetic Nerve Blocked Rats / 대한구급학회지

BACKGROUND: Blood brain barrier disruption (BBBD)increases therapeutic agents delivery to brain diseases.Increasing the delivery of therapeutic drugs to the brainimproves out come f or patients with brain tumors.Cervical sympathetic chain block can increase the degree of mannitol induced blood brain barrier disruption in rats.Anesthetic agents may modify hyperosmolar blood brain barrier disruption.Therefore we evaluated the effecfs of pentobarbital and propofol on mannitol induced blood brain barrier disruption(BBBD)in cervical sympathetic nerve blocked rats. METHODS: 14 male Sprague-Dawley rats were divided into 2 groups.Intravenous pentobarbital (group 1,n=7)and propofol (group 2,n=7)were administrated.Rats was blocked with 0.5% bupivacaine on right cervical sympathetic chain.All rats received 37degrees C,25%mannitol (1.75 g/kg) via right carotid artery.BBBD was estimated by Evans blue staining in cerebral hemisphere. RESULTS: Both groups showed BBBD in right side hemisphere and there was no significant difference between group 1 and group 2 in right side hemisphere. CONCLUSIONS: The results suggest that propofol could be used to be anesthetics for BBBD in cervical sympathetic blocked rats.

Hemodynamic Changes during a Thoracoscopic Thoracic Sympathicotomy in Primary Hyperhidrosis / 대한마취과학회지

BACKGROUND: A right thoracoscopic thoracic sympathicotomy involves the removal of T2 and T3 sympathetic chains. Since part of the sympathetic fibers to the heart traverse these two ganglia, we examined the hemodynamic changes during a thoracoscopic thoracic sympathicotomy in primary hyperhidrosis. METHODS: Noninvasive cardiac output monitoring was done on the both side of the neck and chest. A physiograph for measuring of continuous blood flow was taken from the right index finger and a thermometer was placed in the right palm. Following endotracheal intubation was done with double lumen endotracheal tube, anesthesia was maintained with isoflurane. Sympathicotomies were done for T2-3 during one lung ventilation. Heart rate (HR), mean arterial pressure (MAP), systemic vascular resistance index (SVRI), cardiac index (CI), accelerated contractility index (ACI), end-diastolic index (EDI), and temperature were recorded at arrival, before sympathicotomy, after sympathicotomy at 1, 2, 3, 4 and 5 minuets. The blood flow of the right index finger was recorded before and after the sympathicotomy. RESULTS: Concurrent with initiation of the sympathicotomy, MAP and SVRI were reduced, but the CI was elevated. It was accompanied with right palmar temperature elevation and an increase in the blood flow of the right index finger. CONCLUSIONS: A thoracoscopic thoracic sympathicotomy reduces MAP and SVRI and elevates CI, palmar temperature, and blood flow. We concluded that the hemodynamic changes during a thoracoscopic thoracic sympathicotomy seems to be the peripheral vasodilatation.

The Effect of Cervical Sympathetic Nerve Block on Blood-brain Barrier Disruption with Mannitol Infusion in Rats / 대한구급학회지

BACKGOUND: The barrier can be altered by a number of insults to the brain (e.g., hypertension, freezing, trauma, drug). But the effect of the blood brain barrier distruction immediately after the neural change is unknown. In the present study, we focused on the BBBD after cervical sympathetic chain block. METHODS: 13 male Sprague-Dawley rats were divided into 2 groups. Group 1 (N=7) was blocked with 0.5% bupivacaine on the right cervical sympathetic chain and group 2 (N=6) was blocked with 0.5% bupivacaine on the bilateral cervical sympathetic chain. All rats received 37degrees C, 25% mannitol (1.75 g/kg) via right carotid artery and then, the effect of cervical sympathetic chain block on blood-brain barrier disruption of four cerebral compartment using 99mTc-human serum albumin and Evans blue was evaluated. RESULTS: Both groups showed blood-brain barrier disruption and there was no significant difference between group 1 and group 2 in the anterior and posterior hemisphere of the right side brain. But group 2 showed significant blood-brain barrier disruption than group 1 in anterior and posterior hemisphere of the left brain (p<0.01). CONCLUSIONS: This results suggest that cervical sympathetic chain block can increase the degree of mannitol-induced blood-brain barrier disruption via neural arch or blood flow change.

A Case of Ganglioneuroma Arising from the Retroperitoneal Sympathetic Chains / 대한비뇨기과학회지

Ganglioneuroma is a very rare benign tumor, arising from the mature sympathetic ganglion cells. The majority of ganglioneuroma are diagnosed in patients older than 10 years and are mostly often located in the posterior mediastinum, followed by the retroperitoneum. Ganglioneuroma is fully differentiated tumor that contains no immature elements. In general, ganglioneuroma is found incidentally, and no symptoms manifested. Complete surgical excision of ganglioneuroma is the treatment of choice. Herein, we report one case of ganglioneuroma arising from the retroperitoneal sympathetic chains in a 52 years old female patients.

THE MORPHOLOGICAL STUDY OF THE SUPERIOR LARYNGEAL NERVE LOOP IN CHINESE / 重庆医科大学学报

Based upon the dissection findings of 60 cadavers (120 sides), the incidence of superior laryngeal nerve loop, connecting between cervical sympathetic chain and superior laryngeal nerve as well as its branches is 98.3%(118 out of 120 sides). In most cases, the loop connected the external laryngeal branch with the sympathetic chain. The shape of external laryngeal branch is looped, but not as traditional linear. The loop is one of the origins of thyroid nerve. The loop can be divided into three categories, the shape of the letter V, U and mixed, it can be subdivided into 5 types and 17 subtypes according to their morphological variations