{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,7]],"date-time":"2026-08-07T18:04:10Z","timestamp":1786125850354,"version":"build-2736575974"},"reference-count":17,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"6","license":[{"start":{"date-parts":[[2021,2,27]],"date-time":"2021-02-27T00:00:00Z","timestamp":1614384000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/journals\/pages\/open_access\/funder_policies\/chorus\/standard_publication_model"}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":["Operative Surg.","ONSURG"],"published-print":{"date-parts":[[2021,5]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>BACKGROUND<\/jats:title>\n                    <jats:p>An enlarged suprameatal tubercle (SMT) can obscure visualization of the trigeminal nerve and require removal during microvascular decompression (MVD) surgery, especially when the superior petrosal vein (SPV) complex is preserved.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>OBJECTIVE<\/jats:title>\n                    <jats:p>To define the incidence and important variables affecting the need for SMT removal with an SPV-sparing trigeminal nerve MVD.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>METHODS<\/jats:title>\n                    <jats:p>\n                      Retrospective single-institution review identified patients who underwent a first-time, SPV-sparing MVD for trigeminal neuralgia (TGN) over a 26-mo period. SMT length (SMT-L), SMT width (SMT-W), and peri-trigeminal cerebellopontine cisternal thickness (CT) were measured from axial high-resolution magnetic resonance images. Need for SMT removal and use of endoscopic assistance was recorded. Data were analyzed using unpaired\n                      <jats:italic toggle=\"yes\">t<\/jats:italic>\n                      -tests, and receiver operating characteristic (ROC)\/area under the curve testing.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS<\/jats:title>\n                    <jats:p>A total of 43 MVD surgeries for TGN on 42 patients (mean age 52.7\u00a0\u00b1\u00a014.4 yr) were analyzed. Mean SMT-L, SMT-W, and CT were 9.8\u00a0\u00b1\u00a01.6, 2.0\u00a0\u00b1\u00a00.8, and 4.2\u00a0\u00b1\u00a01.5 mm, respectively. SMT removal via drilling was required in 4\/43 cases (9.3%). Endoscopic assistance was used in 3 cases (2 SMT removed and 1 SMT preserved). SMT-W was the biggest predictor of the need for SMT removal on ROC analysis (area under the curve 0.97, 0.92-1.0 95% CI). The combined thresholds of SMT-W\u00a0\u2265\u00a03.2 mm and CT\u00a0\u2264\u00a03.5 mm demonstrated 100% sensitive and 100% specificity for the need to remove the SMT on optimal cutoff analysis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSION<\/jats:title>\n                    <jats:p>SMT drilling is necessary in nearly 10% of SPV-sparing MVDs for TGN. The combination of SMT width and cerebellopontine cistern thickness is predictive of the need for SMT removal.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/ons\/opab046","type":"journal-article","created":{"date-parts":[[2021,3,1]],"date-time":"2021-03-01T19:13:08Z","timestamp":1614625988000},"page":"E410-E416","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":7,"title":["Surgical Relevance of the Suprameatal Tubercle During Superior Petrosal Vein-Sparing Trigeminal Nerve Microvascular Decompression"],"prefix":"10.1227","volume":"20","author":[{"given":"Robert C","family":"Rennert","sequence":"first","affiliation":[{"name":"Department of Neurological Surgery, University of California San Diego, San Diego, California, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael G","family":"Brandel","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, University of California San Diego, San Diego, California, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marcus L","family":"Stephens","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, University of Arkansas, Little Rock, Arkansas, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Analiz","family":"Rodriguez","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, University of Arkansas, Little Rock, Arkansas, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thomas W","family":"Morris","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, University of Arkansas, Little Rock, Arkansas, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J D","family":"Day","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, University of Arkansas, Little Rock, Arkansas, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2021,6]]},"reference":[{"issue":"1 Suppl 1","key":"bib1-20251027","first-page":"ONS1","article-title":"Retrosigmoid intradural suprameatal approach: advantages and disadvantages from an anatomical perspective","volume":"59","author":"Chanda","year":"2006","journal-title":"Neurosurgery"},{"issue":"5","key":"bib2-20251027","doi-asserted-by":"crossref","first-page":"1089","DOI":"10.1007\/s00701-020-04242-8","article-title":"Resection of the suprameatal tubercle in microvascular decompression for trigeminal neuralgia","volume":"162","author":"Inoue","year":"2020","journal-title":"Acta Neurochir"},{"issue":"6","key":"bib3-20251027","doi-asserted-by":"crossref","first-page":"E247","DOI":"10.1093\/ons\/opz027","article-title":"Intraoperative management of an enlarged suprameatal tubercle during microvascular decompression of the trigeminal nerve, surgical and anatomical description: 2-dimensional operative video","volume":"17","author":"Peris-Celda","year":"2019","journal-title":"Oper Neurosurg"},{"key":"bib4-20251027","doi-asserted-by":"crossref","first-page":"13","DOI":"10.1016\/j.ijscr.2015.08.010","article-title":"Suprameatal extension of retrosigmoid approach for microvascular decompression of trigeminal nerve: case report","volume":"15","author":"Moreira-Holguin","year":"2015","journal-title":"Int J Surg Case Rep"},{"issue":"2 Suppl 1","key":"bib5-20251027","first-page":"ONS63","article-title":"Management of petrous endostosis in posterior fossa procedures for trigeminal neuralgia","volume":"60","author":"Shenouda","year":"2007","journal-title":"Neurosurgery"},{"issue":"1","key":"bib6-20251027","doi-asserted-by":"crossref","first-page":"E3","DOI":"10.3171\/2018.4.FOCUS18133","article-title":"Safety profile of superior petrosal vein (the vein of Dandy) sacrifice in neurosurgical procedures: a systematic review","volume":"45","author":"Narayan","year":"2018","journal-title":"Neurosurg Focus"},{"issue":"15","key":"bib7-20251027","doi-asserted-by":"crossref","first-page":"S415","DOI":"10.4103\/2152-7806.183520","article-title":"Sacrificing the superior petrosal vein during microvascular decompression. 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