title: Thoracoscopic and anatomic landmarks of Kuntz's nerve: implications for sympathetic surgery.
abstract: BACKGROUND
  Kuntz's nerves (KN) have been blamed for surgical failures of endothoracic sympathectomy. The prevalence of these fibers, however, varies between the surgical (about 10%) and anatomic literature (about 80%). This clinically orientated cadaveric study was conducted to explain this discrepancy, to reveal possible reasons for the low thoracoscopic detection rate, and to define anatomic structures as possible landmarks of KNs.
  
  
  METHODS
  Video-assisted thoracoscopy was performed in 33 thoracic cavities of fresh human cadavers within 48 hours postmortem, followed by anatomic dissection of the first intercostal space. Kuntz's nerves and concomitant blood vessels were of special interest. Statistical analysis included frequencies and chi(2) tests.
  
  
  RESULTS
  Kuntz's nerves were identified in 12.1% by thoracoscopy, whereas anatomic dissection revealed KNs in 66.7% (p = 0.003). Subpleural veins (mean diameter, 2.2 +/- 0.9 mm) parallel to KNs were found in 81.8%. No collateral arteries were identified. Diameters of KNs were 1.4 +/- 0.7 mm; distances between the first thoracic ganglion and the middle of KNs were 9.7 +/- 3.0 mm. Thoracoscopic recognition of these Kuntz veins was higher than that of KNs (62.5% vs 18.2%, p < 0.005).
  
  
  CONCLUSIONS
  The low thoracoscopic detection rate of KNs may be due to the low color contrast of these small fibers. They have, however, most frequently concomitant subpleural veins that are easier to detect. These veins may serve as orientation landmarks of KNs and thus contribute to a more complete denervation improving the outcome of thoracoscopic sympathectomies.
authors.affiliation: Department of Neurosurgery, Medical University of Vienna, Vienna, Austria.
authors.forename: Franz
authors.initials: F
authors.lastname: Marhold
authors.forename: Barbara
authors.initials: B
authors.lastname: Izay
authors.forename: Johannes
authors.initials: J
authors.lastname: Zacherl
authors.forename: Manfred
authors.initials: M
authors.lastname: Tschabitscher
authors.forename: Christoph
authors.initials: C
authors.lastname: Neumayer
mesh_terms: D002102:Cadaver; D006801:Humans; D007367:Intercostal Nerves / Q000033:anatomy & histology* / Q000601:surgery*; D013562:Sympathectomy; D013564:Sympathetic Nervous System / Q000033:anatomy & histology / Q000601:surgery; D020775:Thoracic Surgery, Video-Assisted; D014680:Veins / Q000033:anatomy & histology