{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,3]],"date-time":"2026-04-03T01:50:19Z","timestamp":1775181019367,"version":"3.50.1"},"reference-count":35,"publisher":"Wiley","license":[{"start":{"date-parts":[[2024,3,12]],"date-time":"2024-03-12T00:00:00Z","timestamp":1710201600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Clinical Anatomy"],"abstract":"<jats:title>Abstract<\/jats:title><jats:p>Current advances in the management of the autonomic nervous system in various cardiovascular diseases, and in treatments for pain or sympathetic disturbances in the head, neck, or upper limbs, necessitate a thorough understanding of the anatomy of the cervicothoracic sympathetic trunk. Our objective was to enhance our understanding of the origin and distribution of communicating branches and visceral cervicothoracic sympathetic nerves in human fetuses. This was achieved through a comprehensive topographic systematization of the branching patterns observed in the cervical and upper thoracic ganglia, along with the distribution of communicating branches to each cervical spinal nerve. We conducted detailed sub\u2010macroscopic dissections of the cervical and thoracic regions in 20 human fetuses (40 sides). The superior and cervicothoracic ganglia were identified as the cervical sympathetic ganglia that provided the most communicating branches on both sides. The middle and accessory cervical ganglia contributed the fewest branches, with no significant differences between the right and left sides. The cervicothoracic ganglion supplied sympathetic branches to the greatest number of spinal nerves, spanning from C<jats:sub>5<\/jats:sub> to T<jats:sub>2<\/jats:sub>. The distribution of communicating branches to spinal nerves was non\u2010uniform. Notably, C<jats:sub>3<\/jats:sub>, C<jats:sub>4<\/jats:sub>, and C<jats:sub>5<\/jats:sub> received the fewest branches, and more than half of the specimens showed no sympathetic connections. C<jats:sub>1<\/jats:sub> and C<jats:sub>2<\/jats:sub> received sympathetic connections exclusively from the superior ganglion. Spinal nerves that received more branches often did so from multiple ganglia. The vertebral nerve provided deep communicating branches primarily to C<jats:sub>6<\/jats:sub>, with lesser contributions to C<jats:sub>7<\/jats:sub>, C<jats:sub>5<\/jats:sub>, and C<jats:sub>8<\/jats:sub>. The vagus nerve stood out as the cranial nerve with the most direct sympathetic connections. The autonomic branching pattern and connections of the cervicothoracic sympathetic trunk are significantly variable in the fetus. A comprehensive understanding of the anatomy of the cervical and upper thoracic sympathetic trunk and its branches is valuable during autonomic interventions and neuromodulation. This knowledge is particularly relevant for addressing various autonomic cardiac diseases and for treating pain and vascular dysfunction in the head, neck, and upper limbs.<\/jats:p>","DOI":"10.1002\/ca.24149","type":"journal-article","created":{"date-parts":[[2024,3,12]],"date-time":"2024-03-12T08:45:48Z","timestamp":1710233148000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["Anatomical study with clinical significance of communicating and visceral branching of the cervical and upper thoracic sympathetic trunk"],"prefix":"10.1002","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7887-7986","authenticated-orcid":false,"given":"Verena B.","family":"Franco\u2010Riveros","sequence":"first","affiliation":[{"name":"School of Medicine, Department of Human Anatomy, First Unit, Cardiovascular Anatomy Lab Buenos Aires University  Buenos Aires Argentina"},{"name":"School of Medicine, Department of Pathology, Institute of Cardiovascular Physiopathology (INFICA) Buenos Aires University  Buenos Aires Argentina"},{"name":"National Scientific and Technical Research Council (CONICET), Institute of Biochemistry and Molecular Medicine (IBIMOL) Buenos Aires University School of Medicine  Buenos Aires Argentina"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5962-0237","authenticated-orcid":false,"given":"Sof\u00eda M.","family":"Pividori","sequence":"additional","affiliation":[{"name":"School of Medicine, Department of Human Anatomy, First Unit, Cardiovascular Anatomy Lab Buenos Aires University  Buenos Aires Argentina"},{"name":"Diagnostic Imaging Department Hospital Brit\u00e1nico  Buenos Aires Argentina"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-2867-4165","authenticated-orcid":false,"given":"Tom\u00e1s I.","family":"Martin","sequence":"additional","affiliation":[{"name":"School of Medicine, Department of Human Anatomy, First Unit, Cardiovascular Anatomy Lab Buenos Aires University  Buenos Aires Argentina"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0007-7441-4619","authenticated-orcid":false,"given":"Florencia E.","family":"Nicora","sequence":"additional","affiliation":[{"name":"School of Medicine, Department of Human Anatomy, First Unit, Cardiovascular Anatomy Lab Buenos Aires University  Buenos Aires Argentina"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-9970-7586","authenticated-orcid":false,"given":"Mar\u00eda Cecilia","family":"Lallana","sequence":"additional","affiliation":[{"name":"School of Medicine, Department of Human Anatomy, First Unit, Cardiovascular Anatomy Lab Buenos Aires University  Buenos Aires Argentina"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8813-3240","authenticated-orcid":false,"given":"Agustina A.","family":"Pontecorvo","sequence":"additional","affiliation":[{"name":"School of Medicine, Department of Human Anatomy, First Unit, Cardiovascular Anatomy Lab Buenos Aires University  Buenos Aires Argentina"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-3252-3412","authenticated-orcid":false,"given":"Juan Carlos","family":"Flores","sequence":"additional","affiliation":[{"name":"Postgraduate Universitary Training at Interventional Procedures for Chronic Refractory Pain CAIDBA Comprehensive Pain Center Foundation; and La Plata University School of Medical Sciences  La Plata, Buenos Aires Argentina"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1317-1047","authenticated-orcid":false,"given":"Richard Shane","family":"Tubbs","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Tulane Center for Clinical Neurosciences Tulane University School of Medicine  New Orleans Louisiana USA"},{"name":"Department of Anatomical Sciences St. George's University  St. George's West Indies"},{"name":"Department of Structural and Cellular Biology Tulane University School of Medicine  New Orleans Louisiana USA"},{"name":"Department of Neurosurgery and Ochsner Neuroscience Institute Ochsner Health System  New Orleans Louisiana USA"},{"name":"Department of Neurology Tulane University School of Medicine  New Orleans Louisiana USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1221-1214","authenticated-orcid":false,"given":"Andr\u00e9 P.","family":"Boezaart","sequence":"additional","affiliation":[{"name":"Acute and Perioperative Pain Medicine, Department of Anesthesiology University of Florida College of Medicine  Gainesville Florida USA"},{"name":"Lumina Health Pain Medicine Collaborative  Surrey UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9078-1020","authenticated-orcid":false,"given":"Miguel A.","family":"Reina","sequence":"additional","affiliation":[{"name":"Acute and Perioperative Pain Medicine, Department of Anesthesiology University of Florida College of Medicine  Gainesville Florida USA"},{"name":"School of Medicine CEU\u2010San\u2010Pablo University  Madrid Spain"},{"name":"Department of Anesthesiology Madrid\u2010Montepr\u00edncipe University Hospital  Madrid Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6712-8103","authenticated-orcid":false,"given":"Bruno","family":"Buchholz","sequence":"additional","affiliation":[{"name":"School of Medicine, Department of Human Anatomy, First Unit, Cardiovascular Anatomy Lab Buenos Aires University  Buenos Aires Argentina"},{"name":"School of Medicine, Department of Pathology, Institute of Cardiovascular Physiopathology (INFICA) Buenos Aires University  Buenos Aires Argentina"},{"name":"National Scientific and Technical Research Council (CONICET), Institute of Biochemistry and Molecular Medicine (IBIMOL) Buenos Aires University School of Medicine  Buenos Aires Argentina"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2024,3,12]]},"reference":[{"key":"e_1_2_7_2_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00424-014-1591-2"},{"key":"e_1_2_7_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.athoracsur.2011.01.105"},{"key":"e_1_2_7_4_1","first-page":"172","article-title":"Video\u2010assisted thoracoscopic sympathetic ramicotomy for hyperhidrosis\u2010a way to reduce the complications","volume":"90","author":"Cheng Y. 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