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
Visceral Plexuses and Visceral Ganglia

(plexus viscerales et ganglia visceralia) of the thoracic, abdominal cavities and pelvis

I. Thoracic part (pars thoracica).

It contains the following plexuses:

1. Thoracic aortic plexus (plexus aorticus thoracicus) is formed by branches from the 4th-5th upper thoracic ganglia of the Sympathetic trunk and is located in the adventitia of the Thoracic Aorta. Postganglionic sympathetic fibers of this plexus reach Organs and Tissues via periarterial plexuses along the Branches of the thoracic aorta. The plexus contains sensory branches of the vagus nerves

2. Esophageal plexus (plexus oesophagealis) is formed by branches of the upper thoracic ganglia of the sympathetic trunk and branches of the vagus nerves.

3. Pulmonary plexus (plexus pulmonalis) is formed by thoracic pulmonary branches (rr. pulmonales thoracici) of the III and IV thoracic ganglia of the sympathetic trunk and rr. bronchiales n. vagi. It surrounds the roots of the Lungs and the tracheal bifurcation.

4. Cardiac plexus (plexus cardiacus).

Innervation of the heart (Fig. 56).

The sources of cardiac innervation are:

✵ cardiac nerves from the ganglia of the sympathetic trunk;

✵ cervical and thoracic branches of the Vagus nerve;

✵ branches of the right phrenic nerve.

The participation of n. depressor in cardiac innervation remains a matter of debate. All the mentioned sources of cardiac innervation form a single cardiac plexus, which is subdivided into:

1. Extramural cardiac plexuses (superficial and deep).

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Fig. 56. Innervation of The Heart. Sources of Formation of the superficial and deep cardiac plexuses (according to Prof. I. Ye. Kefeli):

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

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

3, 23 - superior cervical cardiac branches (rr. cardiaci cervicales superiores);

4, 24 - inferior cervical cardiac branches (rr. cardiaci cervicales inferiores);

5, 22 - inferior ganglion (g. inferius) of the vagus nerves;

6, 25 - superior cervical ganglion (g. cervicale superius) of the sympathetic trunks;

7, 26 - middle cervical ganglion (g. cervicale medium) of the sympathetic trunks;

8, 27 - cervicothoracic ganglion (stellate ganglion) [g. cervicothoracicum (stellatum)];

9, 10, 11, 12 and 28, 29, 30, 31 - thoracic ganglia (ganglia thoracica) of the sympathetic trunks;

13, 32 - superior cervical cardiac nerves (nn. cardiaci cervicales superiores);

14 - superficial cardiac plexus (plexus cardiacus superficialis);

15 - deep cardiac plexus (plexus cardiacus profundus);

16, 33 - middle cervical cardiac nerves (nn. cardiaci cervicales medii);

17, 34 - inferior cervical cardiac nerves (nn. cardiaci cervicales inferiores);

18, 19, 20, 21 and 35, 36, 37, 38 - thoracic cardiac nerves (nn. cardiaci thoracici);

39, 40 - depressor nerve (n. depressor);

41 - aortic bulb (bulbus aortae);

42 - cardiac contour

Superficial cardiac plexus

is located between the aortic arch and the bifurcation of the pulmonary trunk. It is formed by:

✵ left superior cervical cardiac nerve (n. cardiacus cervicalis superior sinister (from truncus sympathicus) and

✵ left superior cervical cardiac branches (rr. cardiaci cervicales superiores sinistri (from n. vagus sinister);

✵ left inferior cervical cardiac branches (rr. cardiaci cervicales inferiores sinistri)* (from n. vagus sinister)?

Deep cardiac plexus

is situated between the aortic arch and the tracheal bifurcation, formed by the remaining cardiac sympathetic nerves and branches of the vagus nerves.

Sympathetic

Left: middle and inferior cervical cardiac nerves, thoracic cardiac nerves - from truncus sympathicus sinister.

Right: superior, middle, and inferior cervical cardiac nerves, thoracic cardiac nerves - from truncus sympathicus dexter.

Parasympathetic

Left: (inferior cervical — ?) and thoracic cardiac branches — from n. vagus sinister.

Right: superior and inferior cervical as well as thoracic cardiac branches — from n. vagus dexter.

2. Intraorgan cardiac plexus, which ramifies throughout all layers of its wall and is subdivided into:

— subepicardial;

— intramuscular (myocardial);

— subendocardial.

Clusters of parasympathetic Nerve Cells within this plexus, particularly in its subepicardial portion, form cardiac ganglia (ganglia cardiaca) and nodal fields.

According to V. P. Vorobyov, the nodal fields have a regular localization and form six subepicardial cardiac plexuses:

1) right anterior — in the anterolateral region of the right ventricle;

2) left anterior — in the anterolateral region of the left ventricle;

3) anterior atrial plexus — in the anterior walls of the atria;

4) right posterior — in the posterior wall of the right atrium between the openings of the venae cavae, sending a branch to the sinuatrial node of Keith and Flack:

5) left posterior — along the oblique vein of the left atrium, innervating the atrioventricular node of Aschoff and Tawara;

* According to V. P. Vorobyov's scheme of cardiac innervation, the left inferior cervical cardiac branches do not form the superficial cardiac plexus, but are part of the deep one (cited from M. R. Sapin, 1986).

Fig. 57. A. Plexuses and ganglia of the abdominal part. B. Innervation of the Small Intestine.

A. 7 - posterior trunk of the vagus nerve (tr. posterior n. vagi);

2 - left celiac ganglion (g. coeliacum sinister);

3 - superior mesenteric ganglion (g. mesentericum superius);

4 - aorticorenal ganglion (g. aorticorenale);

5 - intermesenteric plexus (plexus intermesentericus);

6 - superior hypogastric plexus (plexus hypogastricus superior);

7,9 - lumbar ganglia (ganglia lumbalia) of the sympathetic trunk;

8 - branches to the abdominal aortic plexus;

10 - lowest splanchnic nerve (n. splanchnicus imus);

11 - lesser splanchnic nerve (n. splanchnicus minor);

12 - greater splanchnic nerve (n. splanchnicus major).

B. 1 - vagus nerve (n. vagus);

2 - intermediate ganglion (2nd order) (g. intermedium);

3 - splanchnic nerve (n. splanchnicus);

4 - celiac ganglion (g. coeliacum);

5 - terminal ganglion (g. terminale);

6 - small intestine (intestinum tenue)

Fig. 58. Autonomic nerve plexuses of the Abdominal cavity:

1 - lesser splanchnic nerve (right) [n. splanchnicus minor (dexter)];

2 - greater splanchnic nerve (right) [n. splanchnicus major (dexter)];

3 - common hepatic artery (a. hepatica communis);

4 - celiac plexus (plexus coeliacus);

5 - celiac ganglion [g. coeliacum (dexter)];

6 - superior mesenteric ganglion [g. mesentericum superius];

7 - superior mesenteric artery (a. mesenterica superior);

8 - renal ganglion (right) [g. renale (dexter)];

9 - inferior mesenteric artery (a. mesenterica inferior);

10 - inferior mesenteric ganglion (g. mesentericum inferius);

11 - iliac plexus (plexus iliacus);

12 - vagus nerve (left) [n. vagus (sinister)];

13 - vagus nerve (right) [n. vagus (dexter)];

14 - left gastric artery (a. gastrica sinistra);

15 - celiac ganglion (left) [g. coeliacum (sinister)];

16 - aorticorenal ganglion (left) [g. aorticorenale (sinister)];

17 - renal plexus (plexus renalis);

18 - intermesenteric plexus (plexus intermesentericus);

19 - lumbar ganglia of the sympathetic trunk (ganglia lumbalia trunci sympathici);

20 - inferior mesenteric plexus (plexus mesentericus inferior);

21 - superior hypogastric plexus (plexus hypogastricus superior)

Fig. 59. Autonomic (vegetative) nerves and plexuses of the abdominal and pelvic organs:

1 - pelvic splanchnic nerves (nn. splanchnici pelvici);

2 - inferior hypogastric plexus (pelvic plexus) [plexus hypogastricus inferior (pelvicus)];

3 - sacral ganglia (ganglia sacralia) of the sympathetic trunk;

4 - hypogastric nerve (right) [n. hypogastricus (dexter)];

5 - superior hypogastric plexus (plexus hypogastricus superior);

6 - lumbar ganglia of the sympathetic trunk (ganglia lumbalia trunci sympathici);

7 - abdominal aortic plexus (plexus aorticus abdominalis);

8 - aorticorenal ganglion (g. aorticorenale);

9 - celiac ganglion (right) [g. coeliacum (dexter)];

10 - superior mesenteric ganglion and superior mesenteric plexus (g. mesentericum superius et plexus mesentericus superior);

11 - inferior mesenteric ganglion and inferior mesenteric plexus (g. mesentericum inferius et plexus mesentericus inferior);

12 - inferior hypogastric (pelvic) plexus [plexus hypogastricus (pelvicus) inferior];

13 - testicular plexus (plexus testicularis)

6) posterior left atrial plexus — located between the openings of the Pulmonary Veins (in the oblique sinus of the Pericardium).

Afferent nerve fibers originate from receptors in the heart wall, belong to the vagus nerve, and are formed by dendrites of pseudounipolar Neurons of the spinal ganglia. These dendrites are incorporated into the sympathetic cardiac nerves.

Efferent postganglionic parasympathetic fibers inhibit Cardiac Activity (bradycardia), whereas sympathetic fibers stimulate myocardial contraction (tachycardia) and dilate the coronary vessels.

II. Abdominal part (pars abdominalis) (Figs. 57, 58)

1. The abdominal aortic plexus (plexus aorticus abdominalis) is formed by branches from the upper lumbar ganglia of the sympathetic trunk, which encircle the Abdominal Aorta and reach the corresponding organs via periarterial plexuses of its branches.

2. The celiac (solar) plexus [plexus coeliacus (solaris)],

often termed the "visceral Brain", surrounds the celiac trunk and is formed by:

— branches of the abdominal aortic plexus;

— right and left greater and lesser splanchnic nerves;

— by branches (rr. coeliaci) of the posterior vagal trunk;

— by branches of the right phrenic nerve;

— by the upper lumbar splanchnic nerves;

— by dendrites of pseudounipolar neurons from the spinal ganglia (C₅–L₃), which are part of all visceral (sympathetic) nerves.

Ganglia (intermediate) of the celiac plexus:

— 2 celiac ganglia (ganglia coeliaca) — located to the right and left of the celiac trunk;

— 2 aorticorenal ganglia (ganglia aorticorenalia) — situated at the branching sites of the right and left renal Arteries. According to some data, this also includes the superior mesenteric ganglion (g. mesentericum superius).

Unpaired derivatives of the celiac plexus:

3. Hepatic plexus (plexus hepaticus) originates from the celiac plexus, runs along the common hepatic artery, and contains fibers from the anterior vagal trunk.

4. Splenic plexus (plexus splenicus).

5. Gastric plexuses (plexus gastrici).

6. Pancreatic plexus (plexus pancreaticus).

Paired visceral plexuses

7. Suprarenal plexus (plexus suprarenalis) — consists of about 20 branches extending from each of the two celiac ganglia toward the Adrenal Glands. Their medulla is innervated by preganglionic sympathetic fibers.

8. Renal plexus (plexus renalis) is formed by branches from the celiac and aorticorenal ganglia, containing renal ganglia (ganglia renalia), which are interconnected with the ureteric plexus (plexus uretericus).

Derivatives of the abdominal aortic plexus

9. Testicular/ovarian plexus (plexus testicularis/ovaricus).

10. Superior mesenteric plexus (plexus mesentericus superior) — a periarterial plexus on the superior mesenteric artery, originating from the abdominal aortic plexus and containing one or two superior mesenteric ganglia (g. mesentericum superius).

11. Intermesenteric plexus (plexus intermesentericus) — the portion of the abdominal aortic plexus situated between the superior and inferior mesenteric arteries.

12. Inferior mesenteric plexus (plexus mesentericus inferior) — a periarterial plexus surrounding the corresponding artery, featuring the inferior mesenteric ganglion (g. mesentericum inferius). This plexus continues as:

13. Superior rectal plexus (plexus rectalis superior).

14. Iliac plexus (plexus iliacus) — a continuation of the abdominal aortic plexus onto the common iliac arteries.

III. Pelvic part (pars pelvica).

15. Superior hypogastric plexus (plexus hypogastricus superior) is formed by several major branches of the abdominal aortic plexus, the lower lumbar and upper sacral splanchnic nerves. It lies on the anterior surface of the fifth lumbar vertebra and the sacral promontory as a thin sheet composed of nerve fibers and ganglia. Inferiorly, the superior hypogastric plexus bifurcates into the right and left hypogastric nerves (nn. hypogastrici dexter et sinister), which continue into:

16. Inferior hypogastric plexus (plexus hypogastricus inferior). This plexus is also formed with the participation of the lower sacral splanchnic nerves and preganglionic parasympathetic fibers (S₂–S₄) from the pelvic splanchnic nerves (nn. splanchnici pelvici). The plexus lies on the superior surface of the levator ani Muscle on both sides of the rectum, giving off numerous branches to the pelvic organs.

Visceral plexuses of the pelvic organs

1. The middle and inferior rectal plexuses (plexus rectales medius et inferior) are formed by branches of the inferior hypogastric, superior, and inferior rectal plexuses, giving rise to the superior anal nerves (nn. anales superiores).

2. The uterovaginal plexus (plexus uterovaginalis) innervates the Uterus, Vagina, and uterine tubes.

3. The prostatic plexus (plexus prostaticus).

4. The Ductus deferens plexus (plexus deferentialis).

Fig. 60. Autonomic innervation of the male pelvic organs:

1 — rectum

2 — inferior mesenteric ganglion (g. mesentericum inferius)

3 — internal anal sphincter (m. sphincter ani internus)

4 — Seminal Vesicle (vesicula seminalis)

5 — Testis

6 — ductus deferens

7 — smooth muscle of the Urethra

8 — prostate (prostata)

9 — Urinary Bladder (vesica urinaria)

10 — Ureter

11 — pelvic (parasympathetic, intramural) ganglia (ganglia pelvica)

Fig. 61. Autonomic innervation of the female pelvic organs:

1 — rectum

2 — inferior mesenteric ganglion (g. mesentericum inferius)

3 — internal anal sphincter (m. sphincter ani internus)

4 — Ovary (ovarium)

5 — Uterine tube (tuba uterina)

6 — Uterus (uterus)

7 — Non-striated Muscles of the urethra

8 — Internal urethral sphincter (m. sphincter urethrae internus)

9 — Urinary bladder (vesica urinaria)

10 — Ureter (ureter)

11 — Pelvic (parasympathetic, intramural) ganglia (ganglia pelvica)

Fig. 62. Innervation of the vascular wall.

1 — tunica interna (intima)

2, 10 — encapsulated nerve corpuscles in the tunica externa (adventitia) and free nerve endings in the tunica media and tunica interna of the vessel (corpusculum nervosum capsulatum et terminatio neuralis libera)

3 — sensory ganglion of spinal nerve (spinal ganglion) ganglion sensorium nervi spinalis (g. spinale)

4 — anterior ROOT of spinal nerve (radix anterior n. spinalis)

5 — white ramus communicans (r. communicans albus)

5a — sympathetic trunk ganglion (g. trunci sympathici)

6 — grey ramus communicans (r. communicans griseus)

7 — postganglionic sympathetic fibers to the tunica media (muscular coat) of the vessel (effector fibers)

8 — tunica externa (adventitia)

9 — tunica media

11 — external elastic membrane (membrana elastica externa)

5. Vesical plexus (plexus vesicalis).

6. Cavernous NERVES OF THE Penis/Clitoris (nn. cavernosi penis/clitoridis).

The walls of hollow organs with pronounced motor activity contain nerve plexuses composed of unmyelinated fibers and small ganglia with ganglionic neurons. This is the metasympathetic Nervous system, also known as the intramural (ganglionated reticular) nervous system. It is well developed in the wall of the digestive tract and is represented by the enteric plexus (plexus entericus), which comprises three plexuses:

— subserous plexus (plexus subserosus) of Vorobyov;

— myenteric plexus (Auerbach's plexus) plexus myentericus (Auerbach);

— submucosal (Meisner's) plexus, plexus submucosus (Meisner).

These plexuses autonomously regulate peristalsis (even in isolated organs) and innervate the glands.