Importance of the Meckel's Cave Anatomy in Skull Base Surgery

Objective: The Meckel's cave (MC), which hosts the trigeminal ganglion, is one of the structures at the base of skull. This cave, the mouth of a natural connection with the posterior fossa, is located in the medial portion of the middle cranial fossa. A complete comprehension of the MC and the microsurgical anatomy of this area is a prerequisite to accomplishing an appropriate surgical strategy and, ultimately, to completing successful exploration and removal of pathological lesions in this region.

Methods: The microsurgical anatomy of the MC was studied in 15 human cadaver heads (30 sides). In one additional specimen, serial histological sections were made to understand the meningeal architecture and the cross-sectional anatomy of the Meckel's cave. They were studied with the aid of an operating microscope.

Results: The MC is a dural cleft; it is situated at the impressio trigemini on the petrous apex, and at the inferolateral surface of the parasellar venous plexus (cavernous sinus). The cave extends forwards like an open-ended three-fingered glove. It consists of the rootlets of trigeminal nerve, the trigeminal ganglion and ophthalmic (V1), maxillary (V2), mandibular (V3) nerve as well, until they reach their respective foramina, and of the trigeminal cistern, arachnoid of the trigeminal ganglion.

Conclusion: An adequate knowledge of the microsurgical anatomy of MC, which borders the internal carotid artery and the cavernous sinus, is essential for skull base surgery. This study provides a better understanding of the Meckel's cave to improve surgical orientation and strategy.