Trigeminal Neuralgia due to Venous Compression Successfully Transposed by Suprameatal Tubercle Drilling

A patient with trigeminal neuralgia due to venous compression was successfully treated by transposition achieved by drilling the suprameatal tubercle. A 53-year-old woman presented with classical trigeminal neuralgia affecting the maxillary division of the right trigeminal nerve. MRI and CT revealed a bony prominence, called the suprameatal tubercle, above the opening of the internal acoustic meatus. MRI showed a thick venous flow void interposed between the suprameatal tubercle and trigeminal nerve. The patient underwent retrosigmoid craniotomy. The bony prominence restricted transposition of the compressed vein, so the compressed vein was successfully transposed after drilling the prominence. The patient's symptoms resolved completely. Drilling the suprameatal tubercle is useful for transposing sandwiched compression vessels.