Anatomy of the Vessels and Nerves of the Trunk (Angioneurology) - Chornokulskyi S. T. 2011

Autonomic (Vegetative) Nervous System
Peripheral Division of the Autonomic Nervous System

The axons of the autonomic Neurons from the aforementioned centers form bundles of nerve fibers, branches, and nerves that initiate the Peripheral Division of the Autonomic Nervous system and function as preganglionic fibers. Furthermore, these serve as the first efferent neurons, whereas the bodies of the second efferent neurons are located outside the Brain AND SPINAL cord within autonomic ganglia (Fig. 50).

The peripheral Parasympathetic division of the craniocervical region and, in part, the sympathetic division are detailed in the study guide "Anatomy of the Vessels and NERVES OF THE HEAD and Neck".

The peripheral division of the sacral (pelvic) part of the parasympathetic nervous system comprises:

— pelvic splanchnic nerves (nn. splanchnici pelvici), and

— pelvic ganglia (ganglia pelvica) and their branches.

Class="center">

Fig. 51. Localization of the centers of the Autonomic (vegetative) nervous system in the Brainstem and Spinal Cord.

Mesencephalic center (parasympathetic):

1 - accessory oculomotor Nucleus (Edinger-Westphal-Yakubovich nucleus) (nuc. accessorius nervi oculomotorii) and unpaired nucleus (Perlia's nucleus) (nuc. impar).

Bulbar center (parasympathetic):

2 - superior salivatory nucleus (nuc. salivatorius superior) and lacrimal nucleus (nuc. lacrimalis).

3 - inferior salivatory nucleus (nuc. salivatorius inferior).

4 - dorsal Nucleus of the Vagus nerve (nuc. dorsalis nervi vagi).

Thoracolumbar center (sympathetic) C₈-L_2,3:

5 - intermediolateral nucleus (nuc. intermediolateralis).

Sacral center (parasympathetic)

S₂-S₄:

6 - sacral parasympathetic nuclei (nuclei parasympathici sacrales)

Fig. 52. Topography of the vagus nerves in the neck region (retropharyngeal space) and posterior Mediastinum on a frontal section.

1 - pharyngobasilar fascia (fascia pharyngobasilaris);

2 - superior pharyngeal constrictor Muscle (m. constrictor pharyngis superior);

3 - middle pharyngeal constrictor muscle (m. constrictor pharyngis medius);

4 - inferior pharyngeal constrictor muscle (m. constrictor pharyngis inferior);

5 - left common carotid artery (a. carotis communis sinistra);

6 - left Subclavian Artery (a. subclavia sinistra);

7 - aortic arch (arcus aortae);

8 - left vagus nerve (n. vagus sinister);

9 - Stomach (ventriculus);

10 - Spleen (liеn);

11 - Pancreas (pancreas);

12 - superior cervical ganglion of the Sympathetic trunk (ganglion cervicale suреrіus truncі sympathicі);

13 - Accessory nerve (n. accessorius);

14 - right Internal jugular vein (v.jugularis interna dextrа);

15 - right common carotid artery (а. carotis communis dextra);

16 - sternocleidomastoid muscle (m. sternocleidomastoideus);

17 - Thyroid Gland (gl. thyroidea);

18 - Esophagus (cervical part) oesophagus (pars cervicalis);

19 - inferior thyroid artery (a. thyroidea inferior);

20 - right subclavian artery (а. subclavia dextra);

21 - right recurrent laryngeal nerve (n. laryngeus recurrens dexter);

22 - bifurcation of Trachea (bifurcatio tracheae);

23 - esophagus (thoracic part) oesophagus (pars thoracica);

24 - right vagus nerve (n. vagus dexter);

25 - right lung (pulmo dexter);

26 - esophageal hiatus (hiatus oesophageus);

27 - esophagus (abdominal part) oesophagus (pars abdominalis)

Fig. 53. Sympathetic trunks and their connections with Spinal Nerves. C₁; Th₁; S₁; Со₁ - first: cervical, thoracic, lumbar, sacral, and coccygeal nerves:

1 - superior cervical ganglion (g.cerviale superius);

2 - stellate ganglion (g. stellatum);

3 - gray rami communicantes (rami communicantes grisei);

4 - white rami communicantes (rami communicantes albi);

5 - ansa subclavia;

6 - vertebral ganglion (g. vertebrale);

7 - middle cervical ganglion (g. cervicale medium)

Fig. 53a. Cervical part of the right trunci sympathici

Pelvic splanchnic nerves are a collection of preganglionic axons of neurons from the nuclei parasympathici sacrales (S₂—S₄) that synapse on neurons of pelvic ganglia located within the inferior hypogastric plexus (plexus hypogastricus inferior). Pelvic ganglia are also present within the middle and inferior rectal, vesical, uterovaginal, and prostatic Autonomic plexuses, as well as the plexus of the Ductus deferens. Postganglionic fibers form the nerves that innervate the pelvic Organs:

— superior rectal nerves (nn. anales superiores);

— vaginal nerves (nn. vaginales);

— cavernous nerves of the Penis/Clitoris (nn. cavernosi penis/clitoridis).

These nerves also contain postganglionic sympathetic and sensory fibers

Peripheral division of the Sympathetic part

It includes:

1. Right and left sympathetic trunks (trunci sympathici dexter et sinister);

2. Gray and white rami communicantes (rr. communicantes grisei et albi);

3. Intermediate (prevertebral) ganglia (ganglia intermedia) within autonomic plexuses and near major Arteries;

4. Autonomic nerves extending from the sympathetic trunk ganglia and plexus ganglia to the organs;

5. Perivascular and organ plexuses;

6. Postganglionic sympathetic fibers (in the form of rr. communicantes grisei) within somatic nerves.

Postganglionic sympathetic fibers are significantly longer than preganglionic ones, whereas this ratio is reversed in the parasympathetic chain.

The right and left sympathetic trunks (truncus sympathicus) appear as a chain of 20–25 paravertebral ganglia connected by interganglionic branches (rr. interganglionares). The sympathetic trunks lie on the anterolateral surfaces (right and left) of THE Vertebral Column, extending from the Base of the Skull to the coccyx, where they unite in a single unpaired ganglion (g. impar). White rami communicantes (rr. communicantes albi)—representing preganglionic fibers—pass from the intermediolateral Cell column of the thoracolumbar region (C8—L2.3) to the ganglia.

From the sympathetic trunk ganglia, after synapsing, gray rami communicantes (rr. communicantes grisei) (postganglionic) extend to all spinal nerves, along with visceral nerves (primarily preganglionic) directed toward the intermediate ganglia.

Sympathetic trunk ganglia are classified as first-order ganglia, while intermediate ganglia are considered second-order ganglia. Parasympathetic ganglia are third-order ganglia.

There are four distinct PARTS OF THE sympathetic trunk:

cervical, thoracic, lumbar, and sacrococcygeal (pelvic).

I. Cervical part

Contains three ganglia (superior, middle, and inferior cervical ganglia — ganglia cervicalia superius, medium et inferius). Preganglionic fibers (from nuclei intermediolaterales C8, Th1—Th7) reach these ganglia via ascending interganglionic Branches of the sympathetic trunk. The cervical ganglia lie beneath the prevertebral fascia on the Deep Muscles of the Neck.

A. Superior cervical ganglion

(g. cervicale superius) is located anterior to the transverse processes of C_II—C_III. It is spindle-shaped (2.5 x 0.5 cm) and represents the largest of the tr. sympathicus ganglia. It gives rise to postganglionic fibers that form various nerves.

Nerves (branches) of the superior cervical ganglion

1. Internal carotid nerve (n. caroticus internus) accompanies the Internal Carotid Artery and its branches, forming the internal carotid plexus (plexus caroticus internus) and plexuses of its branches. It gives off:

— caroticotympanic nerves (nn. caroticotympanici);

— deep petrosal nerve (n. petrosus profundus, acting as radix sympathica g. pterygopalatini);

— ophthalmic plexus (plexus ophthalmicus), from which the radix sympathica to g. ciliare arises;

— pineal nerve (n. pinealis).

2. External carotid nerves (nn. carotici externi) form the external carotid

plexus (plexus caroticus externus), encircling the External Carotid Artery.

3. Common carotid plexus (plexus caroticus communis), together with branches of the IX and X cranial nerve pairs, innervates the carotid body (glomus caroticus).

4. Jugular nerve (n. jugularis) lies on the wall of the internal jugular vein and branches out within the jugular foramen, joining the ganglia and branches of the IX and X pairs, as well as the trunk of the XII cranial nerve pair.

5. Laryngopharyngeal branches (rr. laryngopharyngei) form the sympathetic component of the laryngopharyngeal plexus.

6. Superior cervical cardiac nerve (n. cardiacus cervicalis superior): the left branch runs to the superficial cardiac plexus, while the right branch goes to the deep cardiac plexus.

7. Gray communicating branches to the I—IV cervical spinal nerves, as well as to the hypoglossal and phrenic nerves.

Fig. 54. Vessels and nerves of the neck* (see p. 97)

Fig. 54. Vessels and nerves of the neck.

1 - sternocleidomastoid muscle (m. sternocleidomastoideus);

2 - omohyoid muscle (m. omohyoideus);

3 - common carotid artery (a. carotis communis);

4 - external carotid artery (a. carotis externa);

5 - internal carotid artery (a. carotis interna);

6 - inferior thyroid artery (a. thyroidea inferior);

7 - thyroid gland (glandula thyroidea);

8 - thyrocervical trunk (truncus thyrocervicalis);

9 - subclavian artery (a. subclavia);

10 - anterior scalene muscle (m. scalenus anterior);

11 - suprascapular artery (a. suprascapularis);

12 - superficial branch (r. superficialis);

13 - vertebral artery (a. vertebralis);

14 - transverse cervical artery (a. transversa colli);

15 - middle scalene muscle (m. scalenus medius);

16 - posterior scalene muscle (m. scalenus posterior);

17 - internal jugular vein (v. jugularis interna);

18 - facial vein (v. facialis);

19 - middle thyroid vein (v. thyroidea media);

20 - subclavian vein (v. subclavia);

21 - right brachiocephalic vein (v. brachiocephalica dextra);

22, 23 - External Jugular Vein (vV. jugularis externa);

24 - suprascapular vein (v. suprascapularis);

25 - Right lymphatic duct (ductus lymphaticus dexter);

26 - ansa cervicalis (ansa cervicalis);

27 - superior ROOT (radix superior);

28 - hypoglossal nerve (n. hypoglossus);

29 - inferior root (radix inferior);

30 - phrenic nerve (n. phrenicus),

31 - vagus nerve (n. vagus);

32 - superior cervical cardiac branches (rr. cardiaci cervicales superiores);

33 - inferior cervical cardiac branches (rr. cardiaci cervicales inferiores);

34 - sympathetic trunk (truncus sympathicus);

35 - superior cervical ganglion (ganglion cervicale superius);

36 - middle cervical ganglion (ganglion cervicale medium);

37 - stellate ganglion (ganglion stellatum);

38 - interganglionic branches (thyroid loop) rr. interganglionares (ansa thyroidea);

39 - inferior cervical cardiac nerves (nn. cardiaci cervicales inferiores);

40 - recurrent laryngeal nerve (n. laryngeus recurrens)

B. The middle cervical ganglion (g. cervicale medium) is located at the level of the CVI transverse process and is inconstant.

Nerves and branches of the middle cervical ganglion

1. The middle cervical cardiac nerve (n. cardiacus cervicalis medius), on both the right and left sides, runs towards the deep cardiac plexus.

2. Gray rami communicantes to the V–VI cervical spinal nerves.

C. The inferior cervical ganglion (g. cervicale inferius) or cervicothoracic (stellate) ganglion [g. cervicothoracicum (stellatum)] is situated at the level of the 1st rib head posterior to the subclavian artery.

Nerves and branches of the inferior cervical ganglion

1. The subclavian loop (ansa subclavia) consists of two branches: the anterior loops around the anterior aspect of the subclavian artery, and the posterior loops around its posterior aspect. Both branches serve as interganglionic connections to the middle cervical ganglion and form the subclavian plexus (plexus subclavius).

2. The inferior cervical cardiac nerve (n. cardiacus cervicalis inferior) passes on both sides to the cardiac plexus.

3. The vertebral nerve (n. vertebralis) ensheathes the vertebral artery, forming the vertebral plexus (plexus vertebralis). Within the transverse foramen of the VI cervical vertebra, there is an inconstant vertebral ganglion (g. vertebrale).

4. Gray rami communicantes to the VII–VIII cervical spinal nerves.

II. Thoracic region

These are 10–12 triangular or spindle-shaped thoracic ganglia (ganglia thoracica) located anterior to the heads of the Ribs. White rami communicantes approach all of these ganglia.

Nerves and branches of the thoracic ganglia

1. Thoracic cardiac nerves (nn. cardiaci thoracici) from the II–V thoracic ganglia run to the deep cardiac plexus as postganglionic sympathetic fibers.

2. Thoracic pulmonary nerves (nn. pulmonales thoracici) and

3. Esophageal nerves (nn. oesophageales) arise from the II–V ganglia and run to the respective organs, where they form plexuses (plexus pulmonalis, oesophagealis) together with branches of the vagus nerve.

4. Branches to the Thoracic Aorta, around which they form the thoracic aortic plexus (plexus aorticus thoracicus). From here, sympathetic nerves reach the walls of the azygos vein, hemiazygos vein, and Thoracic duct.

5. The greater splanchnic nerve (n. splanchnicus major) is formed predominantly by preganglionic fibers that pass transitively through the V–IX thoracic ganglia. Within the nerve, these fibers reach the ganglia of the celiac plexus. Within the trunk of the greater splanchnic nerve at the level of ThXII lies the thoracic splanchnic ganglion (g. thoracicum splanchnicuni).

6. The lesser splanchnic nerve (n. splanchnicus minor) also contains predominantly preganglionic sympathetic fibers from the X and XI thoracic ganglia, which participate in The formation of the celiac plexus and synapse in its ganglia. The n. splanchnicus minor gives off the renal branch (r. renalis) to the aorticorenal ganglion (g. aorticorenalis).

7. The lowest splanchnic nerve (n. splanchnicus imus) originates from the XII thoracic ganglion and is inconstant. It runs to the renal plexus.

8. Gray rami communicantes to all thoracic spinal nerves.

Fig. 55. General diagram of the ganglia and nerves of the sympathetic trunk and their areas of innervation

III. Lumbar part

It contains 3–5 lumbar ganglia (ganglia lumbalia). White rami communicantes approach the two upper ganglia. The right and left ganglia are also connected by transverse branches. The following arise from each lumbar ganglion:

1. Lumbar splanchnic nerves (nn. splanchnici lumbales) to the abdominal plexuses.

2. Gray rami communicantes to the lumbar spinal nerves.

IV. Sacrococcygeal (pelvic) part

It comprises 4 paired ganglia and one unpaired ganglion located medially to the pelvic sacral foramina and anterior to the coccyx. The right and left ganglia, as in the lumbar part, are connected by transverse branches. The following arise from the ganglia:

1. Sacral splanchnic nerves (nn. splanchnici sacrates) to the pelvic plexuses.

2. Gray rami communicantes to the sacral and coccygeal spinal nerves.