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- Department of Neurosurgery, Social Security Institute of the Mexico State and Municipalities, ISSEMyM Medical Center “Lic. Arturo Montiel Rojas”, Metepec, México State, Mexico
- Department of Neurosurgery, Interzonal General Acute Hospital Petrona V. de Cordero, Ministry of Health, San Fernando, Argentina
- Department of Neurosurgery, Padilla Hospital of Tucumán, San Miguel de Tucumán, Argentina
- Department of Neurosurgery, San José Hospital – Health Sciences University Foundation, Bogotá, Colombia
- Department of Neurosurgery, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
Correspondence Address:
Abraham Gallegos Pedraza, Department of Neurosurgery, Social Security Institute of the Mexico State and Municipalities, ISSEMyM Medical Center “Lic. Arturo Montiel Rojas,” Metepec, México State, Mexico.
DOI:10.25259/SNI_288_2025
Copyright: © 2025 Surgical Neurology International This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-Share Alike 4.0 License, which allows others to remix, transform, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms.How to cite this article: Abraham Gallegos Pedraza1, Matias Baldoncini2, Álvaro Campero3, Edgar G. Ordonez-Rubiano4, Mariano Montes de Oca Delgado1, Yazeed Mohammed Aldhfyan5, Mickaela Echavarría Demichelis2. Enlarged suprameatal tubercle drilling for distal venous microvascular decompression of the trigeminal nerve, anatomical description: Two-dimensional video. 04-Jul-2025;16:276
How to cite this URL: Abraham Gallegos Pedraza1, Matias Baldoncini2, Álvaro Campero3, Edgar G. Ordonez-Rubiano4, Mariano Montes de Oca Delgado1, Yazeed Mohammed Aldhfyan5, Mickaela Echavarría Demichelis2. Enlarged suprameatal tubercle drilling for distal venous microvascular decompression of the trigeminal nerve, anatomical description: Two-dimensional video. 04-Jul-2025;16:276. Available from: https://surgicalneurologyint.com/?post_type=surgicalint_articles&p=13682
Date of Submission
21-Mar-2025
Date of Acceptance
10-Jun-2025
Date of Web Publication
04-Jul-2025
Abstract
Background: An enlarged suprameatal tubercle (EST) has been described as an uncommon anatomical variant that may be encountered during cerebellopontine angle surgery. It can limit exposure during microvascular decompression (MVD) of the trigeminal nerve, particularly when the neurovascular conflict is located distal to the root entry zone (REZ), potentially posing a surgical challenge.
Case Description: We present the case of a 66-year-old woman with a history of medically refractory left-sided V2–V3 typical trigeminal neuralgia, previously treated with radiofrequency ablation without clinical improvement. Magnetic resonance imaging (fast imaging employing steady-state acquisition sequence) demonstrated a vascular loop compressing the left trigeminal nerve. A left retrosigmoid craniotomy was performed. Initial exploration of the REZ showed no arterial contact; the superior cerebellar artery and anteroinferior cerebellar artery were identified without compressive involvement. However, the superior petrosal vein was found to have intimate contact with the trigeminal nerve, forming a loop and producing a visible compression at the entrance to Meckel’s cave, with an indentation on the nerve sheath. The neurovascular conflict was clearly visualized only after careful drilling of an EST. Following this maneuver, MVD was successfully performed using a Teflon pledget. Medical treatment was discontinued postoperatively due to the patient’s longstanding poor response to pharmacological and ablative therapies. The patient had an uneventful recovery, was discharged 48 h after surgery, and experienced complete resolution of neuralgia without new neurological deficits. At 3-month follow-up, she remained in complete remission, with no complications reported.
Conclusion: When addressing neurovascular pathologies of the posterior fossa, a comprehensive understanding of microsurgical anatomy is critical, especially when extending the traditional retrosigmoid approach. Removing the suprameatal tubercle offers several key anatomical and surgical benefits and has been described as a safe option when compression of the nerve is not in the REZ and might be not evident with the initial exposure of anatomical structures.
Keywords: Decompression, Microvascular, Retrosigmoid, Suprameatal, Trigeminal
Video 1
Time Annotations
00:15: Case presentation, 00:47: MRI Compression site, 01:06: Case Discussion, 03:59: Therapeutic decision making, 04:31: Patient position, 05:04: Defining Anatomical Landmarks, 06:35: Craniotomy borders, 06:35: Dural opening, 07:07: Cerebellopontine cistern exposure, 07:23: Dissection of proximal portion of vascular compression, 07:45: Commentary on Endoscope-Assisted Microvascular Decompression, 08:42: Drilling of enlarged suprameatal tubercle, 08:47: Commentary on Advantages and Disadvantages of Suprameatal Tubercle Drilling, 09:45: Dissection of distal portion of vascular compression, 09:44: Microvascular decompression, 10:34: Final view of surgical field, 10:41: Dural closure, 10:59: Postoperative imaging, 11:15: Postoperative evolution, 11:55: Take – home message.
Enlarged suprameatal tubercle drilling for microvascular decompression: surgical technique [
Ethical approval:
Institutional Review Board approval is not required.
Declaration of patient consent:
The authors certify that they have obtained all appropriate patient consent.
Financial support and sponsorship:
Nil.
Conflicts of interest:
There are no conflicts of interest.
Use of artificial intelligence (AI)-assisted technology for manuscript preparation:
The authors confirm that there was no use of artificial intelligence (AI)-assisted technology for assisting in the writing or editing of the manuscript and no images were manipulated using AI.
Video available on:
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The views and opinions expressed in this article are those of the authors and do not necessarily reflect the official policy or position of the Journal or its management. The information contained in this article should not be considered to be medical advice; patients should consult their own physicians for advice as to their specific medical needs.
