Stellate Ganglion

ganglion stellatum

The stellate ganglion is the fusion of the inferior cervical sympathetic ganglion and the first thoracic sympathetic ganglion, present in approximately 80% of individuals. It lies anterior to the longus colli muscle at the level of C7-T1, posterior to the origin of the vertebral artery, and medial to the carotid sheath. It provides postganglionic sympathetic fibres to the head, neck, upper limb, and heart.

Region: Neck

Clinical Relevance

Clinical Notes

Stellate ganglion block is performed for a wide range of conditions including complex regional pain syndrome of the upper limb, hyperhidrosis, phantom limb pain, post-mastectomy pain, vascular insufficiency of the arm, and increasingly for refractory ventricular arrhythmias and vasomotor symptoms of menopause. The block is performed under ultrasound guidance at the C6 level (Chassaignac tubercle) where the vertebral artery is not yet within the foramen, to avoid intravertebral injection. Horner syndrome (ptosis, miosis, anhidrosis) confirms successful block.

Pathology

Common Injuries & Conditions

Iatrogenic Horner Syndrome

Surgical injury to the stellate ganglion during carotid endarterectomy, anterior cervical spine surgery, or radical neck dissection produces Horner syndrome with ptosis, miosis, and anhidrosis that may be transient or permanent.

Stellate Ganglion Block Complications

Inadvertent intravertebral artery injection during stellate ganglion block causes immediate seizure from even a tiny volume of local anaesthetic; recurrent laryngeal nerve palsy, brachial plexus anaesthesia, and pneumothorax are other recognised complications managed with the block performed under ultrasound guidance.