ABSTRACT
Anatomically, there is great variety in the number, size, and location of the lumbar sympathetic ganglia. The first lumbar ganglion lies under the insertion of the crus of the diaphragm and is often inaccessible for removal. Four ganglia are usually found in the lumbar chain, but the number may vary between two and eight. The L2 and L4 ganglia are most constant in position, and the L4 is often located behind the origin of the iliac vessels. Fusion between L1 and L2 can occur, and ejaculation can be disturbed after resection of L2 in such cases. Because of this, it has been recommended that, in male patients, resection of L3 to L4 is sufficient to eliminate vasomotor tone and to cause vasodilation in the foot.[4]
Another anatomic variant is crossover fibers. These can be seen in 15% of cases, and this may account for failure of unilateral sympathetic ablation. The distinction between preganglionic and postganglionic fibers is of no surgical importance, because all preganglionic fibers for the lower extremity are interrupted by resection of the ganglia and the intervening sympathetic trunk. Regeneration of sympathetic fibers can occur if only a short segment of the chain is resected.
