PMC4601953_01
Asterional diagram where craniectomy approach to the retrosigmoid shown.
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We proposed the patient to undergo a surgical exploration of the cisternal segment of nerve, through retrosigmoid approach, see Fig. 1.
Intraoperative picture with the surgical microscope at the level of the left cerebellopontine angle (CPA), where a prominent suprameatal tubercle (ST) is observed at the level of the posterior surface of the rock. Cerebellum (C).
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However, a prominent ST prevented proper observation of all the cisternal segment of the trigeminal nerve, see Fig. 2.
Intraoperative picture with the surgical microscope, where the removal of the suprameatal tubercle.
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It was decided to drill the ST, see Fig. 3.
Intraoperative picture with the surgical microscope, where it already has resected the suprameatal tubercle:Suprameatal extension of retrosigmoideo approach; here the vascular compression of the trigeminal nerve (CN V) is observed Meckels level segment. The vessel that is committed is a branch of the superior cerebellar artery (SCA).
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The vascular compression of the nerve was observed in such segment caused by a branch of the superior cerebellar artery located behind the trigeminal pore, see Fig. 4.
Intraoperative picture with the surgical microscope, where as a piece of Teflon  between the trigeminal nerve and the vessel is placed.
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The vessel was cautiously separated from the nerve and placed a piece of Teflon  between them, see Fig. 5.
Intraoperative surgical microscope photo with, where subsequent reconstruction of a bone defect removal suprameatal tubercle shown.
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