Translation

it is two neuron disynaptic system in which responses are mediated through autonomic ganglia and the ultimate regulation occurs in the hypothalamus. Outflow from the hypothalamus to spinal levels involves multiple pathways that are not clearly defined. Anatomically, the sympathetic nervous system has outflow in the thoracic and upper lumbar regions of the spinal cord. Preganglionic fibers from the intermediolateral cell column exit the spinal cord through the ventral nerve roots into spinal nerves and enter the paravertebral chain ganglia, coursing through the myelinated white rami communicantes. Once in the ganglia, the pre synaptic neuron can (1) synapse with a post ganglionic neuron and exit as a gray ramus to the viscera, (2) synapse with a post ganglionic neuron and exit as a gray ramus in a segmental nerve, (3) travel up or down the sympathetic chain, (4) stimulate the adrenal gland, or (5) exit the sympathetic chain in the splanchnic nerves and enter peripherally located ganglia such as the the mesenteric ganglia. Postganglionic fibers travel from receptors through the dorsal spinal roots to enter the spinal cord, where they can trigger reflexes through spinal cord interneurons and efferent autonomic fibers. The autonomic ganglia are variable in size, number, and location. There are generally three cervical ganglia ( superior, inferior, middle). The lowest servical ganglia can fuse with the highest thoracic ganglia to form the stellate or cervicothoracic ganglion. Pupillary dilatation occurs as a result of sympathetic output from the spinal cord ciliospinal center of budge. The preganglionic fibers exit the spinal cord at the T1 dan T2 levels and travel through the thoracic, stellate, and middle cervical ganglia to synapse in the superior cervical ganglia, then post ganglionic fibers enter the sympathetic plexus surrounding the carotid artery and travel along the third, fifth, and sixth cranial nerves to enter the orbit and pass through the cilliary ganglion to the pupillary dilators via the long anterior ciliary nerves. A lesion anywhere along this course is manifested by pupillary miosis, anhidrosis ( loss of sympathetic innervation to the sweat glands of the face), ptosis (loss of innervation of the superior tarsal musculature) and occasionally, enophthalmos. The thoracic ganglia ganglia correlate with the the corresponding thoracic level, as do the upper lumbar ganglia. Sexual function and urinary fungtion are also influenced by the anatomic nervous system. Sympathetic efferent innervation to the bladder arises from the lower thoracic and and upper lumbar levels. The efferent nerves travel through a series of ganglia in the sacral region, and the postganglionic fibers travel to the vesicular plexus via the hypogastric nerves. There is also sympathetic stimulation involved in both erection and ejaculation in male patients. The neurochemical aspects are that the presynaptic sympathetic neurons are generally believed to release acetylcholine and peptides that act on muscarinic, nicotinic, or peptidergic receptors of the postsynaptic neurons, which in turn release norepinephrine to achive stimulatory responses in the innervated organs.

The effects of a sympathetic denervation for the treatment of hyperhidrosis presumably occur by interrupting cutaneous sweating and vasoconstriction mediated by the sympathetic nervous system. The mechanisms of a sympathectomy for treating pain ischemic syndromes are mediated through less-well-understood pathways from the denervated sympathetic input by a sympathectomy will achieve at least temporary improvement in the pain symptoms.

Evaluasi Preoperatif Pasien dengan syndrome anatomis membutuhkan evaluasi diagnostic dan penanganan medis intensif sebelum penanganan operasi. Dengan riwayat penyakit dan pemeriksaan fisis sangat penting untuk memulai evaluasi untuk memikirkan kemungkinan penyakit metabolic, infeksi, neoplasma, dan evaluasi radiologi baik dengan foto polos maupun pemeriksaan CT ataupun MRI untuk toraks dan plexus brachialis jika dibutuhkan. Bagaimanapun, diagnostic preoperative paling banyak terbatas, terutama buat pasien dengan nyeri kronis.