cervical sympathectomy

The inner ear sympathetic nerve comes from the stellate ganglion, and the posterior segmental fibers accompany the vertebral artery, basilar artery, and anterior inferior cerebellar artery into the inner ear. The astigmatic stellate ganglion can be resected by sympathectomy around the vertebral artery. Curing disease: Indication Cervical sympathectomy is applied to Meniere's disease caused by sympathetic nerve stimulation caused by vasospasm of the inner ear. Surgical procedure Anesthesia and position Intratracheal intubation is anesthesia. The patient is lying flat, the head is slightly reclined and biased to the opposite side, and the patient is routinely disinfected. Surgical procedure 1. The incision is the midpoint of the posterior margin of the sternocleidomastoid muscle. The incision is made parallel to the clavicle 2cm on the collarbone, about 7cm long, and the skin, subcutaneous tissue and platysma are cut. 2. The sacral nerve is ligated, the external jugular vein is cut, the sternocleidomastoid muscle is separated and pulled, and the clavicular head can be cut and pulled to the inner side. Separate and cut the lower abdomen of the scapula, ligation of the neck traverse, vein, bluntly separate the fat pad on the anterior scalene muscle, expose the phrenic nerve, and pull it aside to protect. 3. Exposing the anterior and deep sides of the anterior scalene muscle of the jugular vein. The second part of the subclavian artery is deep in the muscle. The sternocleidal joint, the inner edge of the anterior scalene muscle, the subclavian vein and the internal jugular vein The innate vein was synthesized. The confluence angle was called the jugular vein angle. There was a thoracic duct on the left side and a lymphatic duct on the right side, all of which were injected into the vein. 4. Cut the anterior scalene muscle at the first rib attachment. In order to avoid damage to the thoracic duct or lymphatic vessels, some muscle fibers are first retained on the inner edge of the muscle, and then the muscles are gradually cut off. At this time, the subclavian artery can be exposed, and if necessary, the nail neck can be ligated. The subclavian artery was pulled down and the rib pleural ligament was cut open, and the pleural top was separated from the first rib and the rib spine. 5. Excision of sympathetic nerve fibers on the adventitia of the vertebral artery: The vertebral artery is exposed on the medial side of the phrenic nerve, and the sympathetic nerve fibers on the adventitia of the artery are removed from the beginning to the entrance of the transverse cervical foramen of the sixth cervical vertebra. 6. The stellate ganglion stellate ganglion is located between the seventh cervical transverse process and the first rib neck. In front of the first rib neck, the stellate ganglion can be seen, and the anterior and posterior pleura is the top of the pleura. Thoracic catheter. The nerve fibers are hooked up with nerve hooks and the branches are cut, and the ends are clamped with silver clips. 7. When the wound is separated and cut, do not damage the nearby small blood vessels, check the wound without oozing, no collateral leakage, suture the sternocleidomastoid muscle cutting site, the anterior scalene muscle does not need to be sutured, and the pressure expands the lung to fill the upper part of the chest cavity. And check for no air leaks, suture the platysma and skin.