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Suprameatal Approach to the Posterior Part of Meckel’s Cave

Surgical Correlation

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A, Right cerebellopontine angle. The suprameatal tubercle is located above the porus of the internal meatus. A large inferior petrosal vein passes behind the vagus nerve. B, The suprameatal tubercle has been removed and the dura extending anteriorly toward Meckel’s cave has been opened to provide 1 cm of additional exposure along the posterior trigeminal root. In addition, access to the side of the clivus is improved. C, Superior view of the suprameatal tubercle. The tubercle is located lateral to the trigeminal nerve, below the superior petrosal vein, and above the internal acoustic meatus and the facial and vestibulocochlear nerves. D, Lateral view after removal of the suprameatal tubercle and the segment of the superior petrosal sinus passing above the porus of Meckel’s cave. This improves the length of the posterior trigeminal root exposed by 8 to 10 mm, compared with the exposure before drilling the tubercle. (Images courtesy of AL Rhoton, Jr.)

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