Tubbs, Shane

ABSTRACT Although ablation of the greater splanchnic nerve is now being used to treat some patients with heart failure, the anatomical relationships between this nerve and the adjacent posterior intercostal veins used for the procedure are not well elucidated. Therefore, the present anatomical study was performed. The anatomy and relationships of the right GSN and the azygos vein were investigated in 50 adult anatomical donors. In the supine position, the anterior wall of the thorax was removed, and the relationship between the azygos vein and its tributaries and the overlying GSN was observed and documented with quantitation of the distances between these structures. At the T7, T8, and T9 vertebral levels, the mean distance between the GSN and the azygos vein was 3.05, 2.35, and 1.62 cm, respectively. We found that the closest distance between the GSN and the azygos vein was at the T9 vertebral level, with a mean distance of 1.62 cm. Therefore, for the shortest distance between vein and GSN, this level should also be considered for ablation level. Such additional anatomical data can help improve patient outcomes and decrease the complication rates of this procedure.

BACKGROUND: Anterior approaches to the cervical spine are among the most common exposures by which neurosurgeons and orthopedic surgeons access the prevertebral space and ultimately the cervical disk and vertebral bodies. There is a paucity of literature describing the microanatomic fascial planes of the neck with respect to anterior cervical approaches. OBJECTIVE: To delineate the microanatomic connections of the cervical fascial planes pertinent to anterior cervical exposure. METHODS: Using a cadaveric model, original illustrations, the Visible Human Project, and an original surgical video, we demonstrate a stepwise method for identifying the correct planes for anterior cervical exposure. RESULTS: A step-by-step method for identifying the anterior cervical fascial planes intraoperatively is demonstrated. CONCLUSION: A comprehensive understanding of anterior cervical microsurgical anatomy is vital for performing a methodical yet efficient approach to the prevertebral space while minimizing retraction and iatrogenic injury to the surrounding neurovascular structures.