Superior petrosal vein in trigeminal neuralgia

During microvascular decompression procedure for trigeminal neuralgia, surgical attention is mainly focused at the neurovascular conflict at trigeminal root entry zone. However, many major complications of this surgery are often related to venous structures in the posterior fossa, including the venous sinuses and the superior petrosal vein(s). The author reviews surgical anatomy of the superior petrosal vein, highlights important surgical steps related to its microsurgical dissection and discusses avoidance of complications, as well as their management during microvascular decompressive surgery in this region. The discussion is mainly focused on the surgical anatomy of the superior petrosal vein along with its significance during surgery and not on the neurovascular relationships of the trigeminal nerve or aetio-pathogenesis of trigeminal neuralgia.