三叉神经痛 (TGN) 的主要原因依赖于小脑上动脉 (SCA) 环和三叉神经 (TN) 背根入口区之间的微血管冲突。然而，沿 TN 的病变被描述为直接占位效应或间接血管转位导致 TGN 的可能原因。因此，对于患有桥小脑角或梅克尔腔肿瘤的患者，应谨慎选择 TGN 的手术方法。乙状结肠后 (RS) 入路采用甲状结肠上延伸，可以直接进入 TN 的脑池和梅克尔腔段，从而可以对血管和肿瘤成分进行最佳的 TN 减压。尽管许多研究中已经描述了具有上皮延伸的 RS 方法，但缺乏详细介绍其解决多组分 TGN 关键步骤的 1-4 视频。在本视频中，我们重点介绍一名 46 岁女性的病例，她患有 6 个月的医学难治性典型 TGN，右侧斑块脑膜瘤累及岩骨、岩斜交界处、梅克尔洞和小脑幕。此外，磁共振成像怀疑背根入口区存在压缩性 SCA 环。患者接受了 RS 入路，经甲上延伸，对肿瘤进行了次全切除，并对 TGN 进行了微血管减压。患者康复，无并发症，TGN 得到解决。版权所有 © 神经外科医生大会 2024。保留所有权利。

The leading cause of trigeminal neuralgia (TGN) relies on the microvascular conflict between the superior cerebellar artery (SCA) loop and the dorsal root entry zone of the trigeminal nerve (TN). However, lesions along the TN have been described as a possible cause of TGN for direct mass effect or indirect vascular transposition. Thus, the surgical approach to TGN in patients harboring cerebellopontine angle or Meckel's cave tumor should be methodically chosen. The retrosigmoid (RS) approach with suprameatal extension offers direct access to the TN in both its cisternal and Meckel's cave segment, allowing optimal TN decompression from vascular and tumoral components. Although the RS approach with suprameatal extension has been described in numerous studies,1-4 videos detailing its key steps in addressing a multicomponent TGN are lacking. In this video, we highlight the case of a 46 year-old woman with 6 months of medically refractory typical TGN with a right en plaque meningioma involving the petrous bone, petroclival junction, Meckel's cave, and tentorium. In addition, magnetic resonance imaging was suspicious for a compressive SCA loop over the dorsal root entry zone. The patient underwent a RS approach with suprameatal extension for subtotal resection of the tumor and microvascular decompression of the TGN. The patient recovered with no complications and TGN resolved.Copyright © Congress of Neurological Surgeons 2024. All rights reserved.