Surgical anatomy of the internal carotid plexus branches to the abducens nerve in the cavernous sinus.

OBJECTIVE: Sympathetic branches to the abducens nerve derived from the internal carotid artery sympathetic plexus, while in the cavernous sinus, have been scantly described in the extant literature. Therefore, the present cadaveric study was performed to better elucidate this anatomy. PATIENTS AND METHODS: Eighteen cadaveric sides underwent dissection. RESULTS: The number of branches derived from the sympathetic plexus traveling with the internal carotid artery in the cavernous sinus was one on 11.1 %, two in 11.1 %, and three in 72.2 %. One side was found to have no branches (5.6 %). The mean diameter of the distance from the posterior border of the internal carotid artery, length, and diameter of the branches was 7.0 ±â€¯4.1 mm, 2.9 ±â€¯1.3 mm, and 0.4 ±â€¯0.1 mm, respectively. Of 44 of 45 sympathetic branches, 97.8 % originated from the lateral wall of the cavernous part of the internal carotid artery with only one from the medial wall. CONCLUSION: Based on our cadaveric findings, sympathetic connections between the internal carotid artery and the abducens nerve are common. Therefore, surgeons who operate in or near the cavernous sinus should be aware of such connections in order not to place unwanted tension on the cavernous part of the internal carotid artery or abducens nerve during dissection.

Nociceptive and sympathetic innervations in the abaxial part of the cranial horn of the equine medial meniscus: an immunohistochemical approach.

In athletic horses, diseases leading to lameness are of great importance due to the loss of performance and the resultant economic concerns. Although stifle lesions are frequent in the hindlimb, due to the large size and complexity of the joint, and although meniscal tears have been identified as the most common soft tissue injuries in this joint, little is known about the mechanism that causes the painful sensation and thus the lameness. The aim of our study was to highlight any peripheral fibres involved in meniscal nociception in five macroscopically sound cranial horns of the equine medial meniscus, which has been one of the most common sites reported for equine meniscal injuries. Immunohistochemical stainings were performed using antibodies against Substance P in order to identify nociceptive fibres; against tyrosine hydroxylase for detecting postganglionic sympathetic fibres; and against glial fibrillary acidic proteins in order to identify Schwann cells. Our work highlights for the first time the presence of nociceptive and sympathetic fibres in equine menisci. They were found in the abaxial part of the cranial horn of the equine medial meniscus. This study suggests that when the abaxial part is injured, the meniscus itself could be the source of pain. These findings could provide a better understanding of the clinical presentation of horses with meniscal injury and contribute towards improving therapeutic strategies to alleviate pain in cases of equine meniscal injury.

Site-dependent differences in density of sympathetic nerve fibers in muscle-innervating nerves of the human head and neck.

The autonomic nerve supply of skeletal muscle has become a focus of interest because it is closely related to the adaptation of energy metabolism with aging. We have performed an immunohistochemistry study on tyrosine hydroxylase (TH) and neuronal nitric oxide synthase (nNOS) using specimens obtained from ten selected elderly cadavers (mean age 83.3 years) in which we examined muscle-innervating nerves (abbreviated ''muscle-nerves'' hereafter) of ten striated muscles (soleus, infraspinatus, extra-ocular inferior rectus, lateral rectus, superior obliquus, temporalis, orbicularis oculi, posterior cricoarytenoideus, trapezius and genioglossus) and, as a positive control, the submandibular ganglion. We found that the extra-ocular muscles received no or very few TH-positive nerve fibers. Muscle-nerves to the other head and neck muscles contained a few or several TH-positive fibers per section, but their density (proportional area of TH-positive fibers per nerve cross-section) was one-half to one-third of that in nerves to the soleus or infraspinatus. We did not find nNOS-positive fibers in any of these muscle-nerves. In the head and neck muscles, with the exception of those of the tongue, there appeared to be very few TH-positive nerve fibers along the feeding artery. Consequently, the head and neck muscles seemed to receive much fewer sympathetic nerves than limb muscles. There was no evidence that nNOS-positive nerves contributed to vasodilation of feeding arteries in striated muscles. This site-dependent difference in sympathetic innervation would reflect its commitment to muscle activity. However, we did not find any rules determining the density of nerves according to muscle fiber type and the mode of muscle activity.

Differential cardiac responses to unilateral sympathetic nerve stimulation in the isolated innervated rabbit heart.

The heart receives both a left and right sympathetic innervation. Currently there is no description of an in vitro whole heart preparation for comparing the influence of each sympathetic supply on cardiac function. The aim was to establish the viability of using an in vitro model to investigate the effects of left and right sympathetic chain stimulation (LSS/RSS). For this purpose the upper sympathetic chain on each side was isolated and bipolar stimulating electrodes were attached between T2-T3 and electrically insulated from surrounding tissue in a Langendorff innervated rabbit heart preparation (n=8). Heart rate (HR) was investigated during sinus rhythm, whilst dromotropic, inotropic and ventricular electrophysiological effects were measured during constant pacing (250 bpm). All responses exhibited linear increases with increases in stimulation frequency (2-10 Hz). The change in HR was larger during RSS than LSS (P<0.01), increasing by 78±9 bpm and 49±8 bpm respectively (10 Hz, baseline; 145±7 bpm). Left ventricular pressure was increased from a baseline of 50±4 mmHg, by 22±5 mmHg (LSS, 10 Hz) and 4±1 mmHg (RSS, 10 Hz) respectively (P<0.001). LSS, but not RSS, caused a shortening of basal and apical monophasic action potential duration (MAPD90). We demonstrate that RSS exerts a greater effect at the sinoatrial node and LSS at the left ventricle. The study confirms previous experiments on dogs and cats, provides quantitative data on the comparative influence of right and left sympathetic nerves and demonstrates the feasibility of isolating and stimulating the ipsilateral cardiac sympathetic supply in an in vitro innervated rabbit heart preparation.

Distribution and chemical coding of sympathetic neurons in the caudal mesenteric ganglion projecting to the ovary in sexually mature gilts.

The distribution and co-localisation patterns of dopamine-beta-hydroxylase (DßH), neuropeptide Y (NPY), somatostatin (SOM) and galanin (GAL) were investigated by use of retrograde neuronal tracing and double-labelling immunofluorescence techniques in the caudal mesenteric ganglion (CaMG) neurons supplying the ovary of adult pigs. The existence and density of nerve fibres that are immunoreactive (IR) for the above-mentioned neuroactive substances were also evaluated. Injections of a fluorescent tracer (Fast Blue; FB) into the ovaries revealed the presence of small- (76.38%) and large-sized (23.62%) FB-positive postganglionic neurons in the CaMG. Noradrenergic FB-positive cells were simultaneously NPY- (43.38%), SOM- (18.77%) and GAL- (18.31%) IR. Of the examined FB-positive neurons, 53.49% were DßH-IR but NPY-immunonegative (IN), 79.06% were DßH-IR but SOM-IN, and 77.16% were DßH-IR but GAL-IN. Small- or large-sized subsets of traced neurons were supplied by only one or a few nerve fibres, exhibiting DßH-, NPY-, SOM- and/or GAL-IR. Our data show the specific morphological as well as immunochemical structural organisation of the sympathetic neurons in the CaMG in adult gilts. The occurrence of an abundant population of noradrenergic perikarya in the CaMG may suggest their important physiological role in the regulation of gonadal function(s) in these animals.

Anterior exposure of the lumbar spine with and without an "access surgeon": morbidity analysis of 265 consecutive cases.

STUDY DESIGN: Retrospective review OBJECTIVE: To compare the incidence and type of exposure-related complications for anterior lumbar surgery performed with and without an "access" surgeon. SUMMARY OF BACKGROUND DATA: No data exist comparing the incidence and type of exposure-related complications for anterior lumbar surgery performed with and without a vascular surgeon's assistance. METHODS: A retrospective review was performed for 265 consecutive patients who underwent anterior lumbar spine surgery at our institution from 2003 to 2005. Each patient's records were reviewed for diagnosis, procedure, whether the surgical exposure was conducted by the spine surgeon (Spine) or with a vascular surgeon's assistance (Team), levels exposed, complications, and any lasting sequelae. RESULTS: The percentage of patients with at least 1 intraoperative complication was 8% and 12% for the Spine and Team cases, respectively. Two percent of the Spine patients experienced an intraoperative vascular complication compared with 7% of the Team cases. No intraoperative vascular complication occurred in the single-level Spine exposures. Four percent of the patients with single-level exposures with Team approaches sustained an intraoperative vascular complication. Eight percent of the multilevel Spine cases sustained an intraoperative vascular complication compared with 9% of the multilevel Team exposures. There were 14 vascular injuries appreciated intraoperatively in a total of 13 patients. These injuries were directly repaired in 10 patients without any residual sequelae. The rate of vascular complications was statistically higher for multiple-level exposures (9%) versus single-level exposure (3%; P = 0.0357). The rate of retrograde ejaculation was 6% in the Spine cases whereas it was 7% in the Team approach. CONCLUSIONS: Our results do not support the notion that the presence of an "access" surgeon will change the type and rate of complications. With adequate training and judgment, spine surgeons may safely perform such exposures, provided vascular surgical assistance is readily available.

Functional asymmetry in the descending cardiovascular pathways from dorsomedial hypothalamic nucleus.

Neurons in the dorsomedial hypothalamus (DMH) play a key role in mediating tachycardia elicited by emotional stress. DMH activation by microinjections of the GABA(A) antagonist evokes tachycardia and physiological changes typically seen in experimental stress. DMH inhibition abolishes the tachycardia evoked by stress. Based on anatomic evidences for lateralization in the pathways from DMH, we investigated a possible inter-hemispheric difference in DMH-evoked cardiovascular responses. In anesthetized rats we compared changes in heart rate (HR), renal sympathetic activity (RSNA), mesenteric blood flow (MBF) and tail vascular conductance produced by activation of right (R) and left (L) sides of the DMH. We also evaluated the tachycardia produced by air jet stress after inhibition of R or L DMH. There were always greater increases in RSNA when bicuculline was injected ipsilaterally to the side where these parameters were recorded (average DeltaRSNA: L=+50% and R=+26%; P<0.05). Compared to pre-injection values, right DMH activation caused pronounced decrease (0.87+/-0.1% vs. 0.4+/-0.11%/mm Hg; P<0.05), whereas bicuculline methiodide (BMI) into left DMH produced no significant changes (0.95+/-0.09% vs. 1.04+/-0.25%/mm Hg) in tail vascular conductance. R or L DMH disinhibition produced decreases in MBF, but no differences in the range of these changes were observed. Activation of the right DMH caused greater tachycardia compared to the left DMH activation (average DeltaHR: R=+92 bpm; L=+48 bpm; P<0.05). Tachycardia evoked by air jet stress was smallest after right DMH inhibition (average DeltaHR: R=+57 bpm and L=+134 bpm; P<0.05). These results indicate that the descending cardiovascular pathways from DMH are predominantly lateralized and the right DMH might exert a prominent control on heart rate changes during emotional stress.

Sympathetic innervation of the spleen in male Brown Norway rats: a longitudinal aging study.

Aging leads to reduced cellular immunity with consequent increased rates of infectious disease, cancer, and autoimmunity in the elderly. The sympathetic nervous system (SNS) modulates innate and adaptive immunity via innervation of lymphoid organs. In aged Fischer 344 (F344) rats, noradrenergic (NA) nerve density in secondary lymphoid organs declines, which may contribute to immunosenescence with aging. These studies suggest there is SNS involvement in age-induced immune dysregulation. The purpose of this study was to longitudinally characterize age-related change in sympathetic innervation of the spleen and sympathetic activity/tone in male Brown Norway (BN) rats, which live longer and have a strikingly different immune profile than F344 rats, the traditional animal model for aging research. Splenic sympathetic neurotransmission was evaluated between 8 and 32 months of age by assessing (1) NA nerve fiber density, (2) splenic norepinephrine (NE) concentration, and (3) circulating catecholamine levels after decapitation. We report a decline in NA nerve density in splenic white pulp (45%) at 15 months of age compared with 8-month-old (M) rats, which is followed by a much slower rate of decline between 24 and 32 months. Lower splenic NE concentrations between 15 and 32 months of age compared with 8M rats were consistent with morphometric findings. Circulating catecholamine levels after decapitation stress generally dropped with increasing age. These findings suggest there is a sympathetic-to-immune system dysregulation beginning at middle age. Given the unique T-helper-2 bias in BN rats, altered sympathetic-immune communication may be important for understanding the age-related rise in asthma and autoimmunity.

Comparative anatomy and evolution of the cardiac innervation in New World monkeys (Platyrrhini, e. Geoffroy, 1812).

The morphology of the autonomic cardiac nervous system (ACNS) was examined in 24 sides of 12 New World monkeys (Platyrrhini) of all four families to document the morphology systematically and to study the evolutionary changes of the ACNS in this primate lineage. We report the following: (1) Although several trivial intra- and inter-specific variations are present, a family-dependent morphology of the ACNS does not exist in New World monkeys. (2) The sympathetic ganglia in New World monkeys consist of the superior cervical, the middle cervical, and the cervicothoracic which is composed of the inferior cervical and first and second thoracic, and the thoracic ganglia starting with the third thoracic. The general cardiac nervous system is the sympathetic middle and inferior cardiac nerves and all parasympathetic vagal cardiac branches. (3) The morphology of the ACNS in the New World monkeys is almost consistent regardless of the number of vertebrae, the cardiac position and deviation (axis), and the great arterial branching pattern of the aortic arch, and it is very similar to that in the Old World monkeys, with only one difference: the superior cervical ganglion in the New World monkeys tends to be relatively smaller, higher, and provides a narrower contribution to the spinal nerves than in the Old World monkeys. The ACNS morphology exhibits significant evolutionary changes within the primate lineage from New and Old World monkeys to humans. The comparative morphology within the lineage is concordant with the phylogeny, suggesting that the primate ACNS preserves its evolutionary history in close alignment with phylogeny.

Resolving discogenic pain.

Recent basic science studies on discogenic low back pain have provided new knowledge about this condition. This paper reviews some of these results and presents an overview of the following findings. The rat lumbar intervertebral disk may be innervated non-segmentally through the paravertebral sympathetic nerve and segmentally through the sinuvertebral nerves, and also by dichotomizing sensory fibers. The exposure of the nucleus pulposus (NP) to the outer annulus fibrosus (AF) may induce nerve injury and ingrowth into the disk. Nerve growth factor (NGF)-sensitive neurons are predominant in the rat intervertebral disk, which indicates that hyperalgesic responses can be induced by inflammation. NGF in the NP may promote axonal growth. Lumbar fusion may inhibit nerve ingrowth into the degenerated disk and reduce the percentage of calcitonin gene related peptide (CGRP)-positive neurons.

Postganglionic horner syndrome in three patients with coincident middle ear infection.

Three patients developed a postganglionic Horner syndrome during the course of an ipsilateral uncomplicated middle ear infection. The mechanism may be an effect on the middle ear caroticotympanic sympathetic plexus, for which there is considerable anatomic and physiologic evidence. Why Horner syndrome does not occur more often after middle ear infection is a mystery.

Anatomic characteristics of the ophthalmic and posterior ciliary arteries.

BACKGROUND: There is little documentation of the course and relations of the ophthalmic artery (OA) and posterior ciliary arteries (PCAs). METHODS: The anatomic characteristics of the OA and PCAs were determined from a dissection of 19 neoprene-injected cadaver heads. RESULTS: The intraorbital OA had three segments, considering its relation to the optic nerve in the sagittal plane. The first segment extended from the point where the OA entered the orbit to its curving point. The second segment coursed superomedially from the inferolateral part of the optic nerve, crossing the optic nerve either superiorly or inferiorly. The third segment extended from the curving point of the superomedial distal portion of the second segment to the vessel's termination. The OA was deviated at the junction of its first and second segments, defined as its "angle"; and at the junction of the second and third segments, defined as its "bend." The PCAs arose from the first OA segment, the angle of the OA, the second OA segment and the OA bend. The patterns of branching of the PCAs were medial and lateral and medial, lateral, and superior. The superior PCA and the lateral PCA arose mainly from the angle of the OA, whereas the medial PCA arose from the curving point of the OA. The most frequently observed PCA pattern was a medial PCA and a lateral PCA. The average diameters of the medial PCA, the superior PCA, and the lateral PCA were 0.65, 0.48, and 0.68 mm, respectively. In all cases, pial arteries branching from the PCA and supplying the optic sheath were observed to form a vascular plexus on the optic sheath. The OA and PCAs were surrounded by a network of sympathetic nerves. CONCLUSIONS: Because the most common pattern of PCAs is a medial and lateral branch, a surgical approach to the orbit from those directions carries a higher risk of damage to those vessels than a superior or inferior approach.

The terminal of the sympathetic nerve fibers in the facial nerve.

OBJECTIVE: The terminal of the sympathetic nerve fibers of the rat facial nerve in the temporal bone region was investigated. MATERIAL AND METHODS: We used tyrosine hydroxylase (TH) and the synaptophysin antibody as markers of the sympathetic nerve fiber and the membrane of the synaptic vesicle, respectively. Using immunohistochemistry, we determined whether and where the synapse exists in the facial nerve of the Sprague-Dawley rat. RESULTS: TH-immunoreactive fibers were confirmed as being present in both the epineurium and the nerve fascicle of the facial nerve. A synaptophysin immunoreaction was found in the facial nerve in a region of the temporal bone. These reaction products looked like varicosities. Most TH-positive fibers in the facial nerve disappeared after superior cervical ganglionectomy. CONCLUSIONS: As the synaptophysin immunoreaction indicates the existence of a synapse, we speculate that the sympathetic fibers affect the facial nerve in the region of the temporal bone. Further studies may be needed to elucidate the function of the sympathetic system in the facial nerve.

Intrinsic choroidal neurons in the human eye: projections, targets, and basic electrophysiological data.

PURPOSE: The chemical coding of intrinsic choroidal neurons (ICNs) has features in common with extrinsic fibers (e.g., from the pterygopalatine ganglion) making it impossible to assess whether a neuronal nitric oxide synthase (nNOS)/vasoactive intestinal polypeptide (VIP)-immunoreactive nerve fiber is of intrinsic or extrinsic origin. Neurobiotin injections into single neurons allow the visualization of projections of these cells and the determination of the origin of target innervation. Thus, this technique was used in the present study to help characterize the organization of the ICN in the human eye. METHODS: ICNs were visualized with the fluorescent vital dye 4-Di-2-ASP. Electrophysiological properties were determined by means of intracellular recordings. The impaled neurons were iontophoretically filled with neurobiotin. After fixation, immunohistochemistry for neuronal nitric oxide synthase (nNOS), alpha-smooth muscle actin, and calcitonin gene-related peptide (CGRP) was conducted. RESULTS: ICN processes were traced over distances of up to 2.612 micro m. They were found in the immediate vicinity of other nNOS-positive or -negative ICNs and were also found apposed to smooth muscle fibers (vascular and stromal nonvascular). CGRP-positive fibers forming boutons were observed closely associated with ICNs. Electrophysiological recording showed phasic firing without slow afterhyperpolarization, no spontaneous activity, an input resistance of 136 +/-73 MOmega, and a membrane time constant of 7 +/- 1 ms. CONCLUSIONS: Apart from the first functional characterization of ICNs, this study provided more precise evidence of reciprocal ICN-to-ICN contacts and innervation of both choroidal nonvascular and vascular smooth muscle. The presented technique offers promising perspectives to further investigate the function of ICNs in ocular homeostasis.

Quantitative analysis of the sympathetic innervation of the rat knee joint.

Retrograde tracing with Fluoro-Gold (FG) was used to identify the complete population of knee joint sympathetic postganglionic efferents in the lumbar sympathetic chain of adult female Wistar rats. In 6 rats, the total number and distribution of FG-labelled neurons in the lumbar sympathetic chain was determined. The rat knee joint is supplied by an average of 187+/-57 sympathetic afferents with the majority at the L3 and L4 levels. Immunohistochemistry using antibodies specific for tyrosine hydroxylase (TH), somatostatin (SS) or vasoactive intestinal polypeptide (VIP) revealed that 33 % of knee joint sympathetic afferents contained TH, 42 % contained VIP, and none contained somatostatin. Retrograde tracing with FG provided accurate and reproducible labelling of the joint-innervating subpopulation of sympathetic efferent neurons. This model lends itself to the further study of the molecular responses of this neuronal population in the various disorders and conditions affecting joints.

Electrophysiological study of relations between the dorsal nerve of the penis and the lumbar sympathetic chain in the rat.

Afferent sensory inputs from the penis are carried by the dorsal nerve of the penis (DNP) to the spinal cord. Sympathetic outflow involved in the control of the urogenital tract is partly conveyed by the lumbosacral sympathetic chain. Our aim was to search for a sympathetic component in the DNP and relations between DNP afferents and sympathetic fibers conveyed by the distal sympathetic chain in anesthetized adult male rats. Stimulation of the lumbar sympathetic chain at the L4-L5 level (LSC4-5) elicited an evoked discharge on the DNP. This discharge was abolished by cutting the sympathetic chain distal to the stimulation site. Ganglionic blockade with hexamethonium and various neural sections revealed the presence of sympathetic postganglionic fibers in the DNP, originating in the sympathetic chain. Stimulation of the DNP evoked a reflex discharge in the LSC. This reflex was spinally mediated since it was abolished by acute spinal cord transection at the L5 level. Acute spinalization at the T8 level significantly reduced the latency of the evoked response. We hypothesize that both spinal and supraspinal control exist over relations of the DNP afferents with sympathetic outflow to the pelvis. Increase in sympathetic tone elicited by activation of penile sensory fibers could play a role in regulation of sexual function.