SURGICAL IMPLICATIONS OF UPPER THORACIC INDEPENDENT SYMPATHETIC PATHWAYS

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Abstract
ANATOMIC data previously reported from these laboratories1 support the assumption that accessory ganglions frequently constitute synaptic relay stations in peripheral sympathetic conduction pathways which do not traverse the sympathetic trunk. Such independent sympathetic pathways afford an anatomic explanation for failure to bring about complete sympathetic denervation, particularly of the extremities, by extirpation of the corresponding segments of the sympathetic trunk or section of the preganglionic fibers which reach these segments of the sympathetic trunk through white communicating rami. The results of a detailed study of accessory sympathetic ganglions in the lower thoracic and the lumbar segments in man and their anatomic relationships, reported by Kuntz and Alexander,2 demonstrate clearly that in many instances the preganglionic fibers which make synaptic contacts in an accessory ganglion reach it directly through the ventral root of the corresponding spinal nerve and that the axons of the ganglion cells with which the synaptic

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