Turkish Neurosurgery 2018 , Vol 28 , Num 1
Uncovering the Forgotten Effect of Superior Cervical Ganglia on Pupil Diameter in Subarachnoid Hemorrhage: An Experimental Study
Mehmet Resid ONEN1,Ilhan YILMAZ2,Leyla RAMAZANOGLU3,Mehmet Dumlu AYDIN4,Sadullah KELES5,Orhan BAYKAL5,Nazan AYDIN6,Cemal GUNDOGDU7
1Umraniye Teaching and Research Hospital, Neurosurgery Clinic, Istanbul, Turkey
2Sisli Teaching and Research Hospital, Neurosurgery Clinic, Istanbul, Turkey
3FSM Teaching and Research Hospital, Neurology Clinic, Istanbul, Turkey
4Ataturk University Medical Faculty, Department of Neurosurgery, Erzurum, Turkey
5Ataturk University Medical Faculty, Department of Ophthalmology, Erzurum, Turkey
6Bakirkoy Teaching and Research Hospital, Psychiatry Clinic, Istanbul, Turkey
7Ataturk University Medical Faculty, Department of Pathology, Erzurum, Turkey
DOI : 10.5137/1019-5149.JTN.16867-16.3 AIM: To investigate the relationship between neuron density of the superior cervical sympathetic ganglia and pupil diameter in subarachnoid hemorrhage.

MATERIAL and METHODS: This study was conducted on 22 rabbits; 5 for the baseline control group, 5 for the SHAM group and 12 for the study group. Pupil diameters were measured via sunlight and ocular tomography on day 1 as the control values. Pupil diameters were re-measured after injecting 0.5 cc saline to the SHAM group, and autologous arterial blood into the cisterna magna of the study group. After 3 weeks, the brain, superior cervical sympathetic ganglia and ciliary ganglia were extracted with peripheral tissues bilaterally and examined histopathologically. Pupil diameters were compared with neuron densities of the sympathetic ganglia and ciliary ganglia which were examined using stereological methods.

RESULTS: Baseline values were; normal pupil diameter 7.180620 ?m and mean neuron density of the superior cervical sympathetic ganglia 6.321510/mm3, degenerated neuron density of ciliary ganglia was 52/mm3 after histopathological examination in the control group. These values were measured as 6.850578 ?m, 5.950340/mm3 and 12339/mm3 in the SHAM group and 9.910840 ?m, 7.950764/mm3 and 65098/mm3 in the study group. A linear relationship was determined between neuron density of the superior cervical sympathetic ganglia and pupil diameters (p<0.005). Degenerated ciliary ganglia neuron density had an inverse effect on pupil diameters in all groups (p<0.0001).

CONCLUSION: Highly degenerated neuron density of the ciliary ganglion is not responsible for pupil dilatation owing to parasympathetic pupilloconstrictor palsy, but high neuron density of the pupillodilatatory superior cervical sympathetic ganglia should be considered an important factor for pupil dilatation. Keywords : Subarachnoid hemorrhage, Pupil diameter, Superior cervical ganglia, Sympathetic innervation, Light reflex

Corresponding author : Mehmet Dumlu AydIn, nmda11@hotmail.com