Up to the present time excision of the cervical sympathetic has been
performed for the following diseases: epilepsy, exophthalmic goiter,
glaucoma, and optic-nerve atrophy. The question naturally arises: How
extensive an operation is necessary in these affections? This I will
attempt to answer:
In epilepsy it is necessary to excise the entire cervical chain on both
sides for the reason that, according to Jonnesco’s theory, it is
necessary to convert a state of cerebral anæmia—which he assumes is the
condition in epilepsy—into one of cerebral hyperæmia. Since the carotid
plexus is formed by branches from the superior ganglion, and the
vertebral plexus arises from branches which have their origin in the
inferior cervical ganglion, it is evident that the entire cervical
sympathetic must be removed.
In exophthalmic goiter, although Jonnesco in his first operation excised
only the superior and middle ganglia, he now believes it necessary to
remove the inferior as well, for this reason: from the superior ganglion
the ocular fibers arise; from the inferior the vasodilator,
cardiac-accelerator, and, probably, the secretory nerves of the thyroid
gland. If eye, thyroid, and cardiac symptoms are to be relieved the
entire chain must be excised.
In glaucoma removal of the superior ganglion alone is necessary. All of
the sympathetic fibers of the eye, with the exception of those which
pass directly from the cerebrum by way of the trigeminus, are connected
with the superior ganglion.
In optic-nerve atrophy, if it should be proved that noninflammatory
atrophy of the optic nerve can be improved by sympathectomy, removal of
the superior ganglion alone will be necessary, for reasons already
given.
If the glaucoma is unilateral, it is necessary to remove only the
corresponding ganglion.