Geniculate ganglion hemangiomas: clinical results and long-term follow-up.

OBJECTIVE

To review the clinical presentation, evaluation, and management of 18 patients with geniculate ganglion hemangiomas seen at the House Clinic.

STUDY DESIGN

Retrospective case review.

SETTING

Private neurotological tertiary referral center.

PATIENTS

Eighteen patients with geniculate ganglion hemangiomas treated at the House Clinic between 1986 and 2008.

INTERVENTION

Observation or surgical intervention using the middle fossa or translabyrinthine craniotomy for decompression or excision of the hemangioma with or without facial nerve resection and grafting.

MAIN OUTCOME MEASURES

Postoperative facial function using the House-Brackmann grading system, postoperative audiograms and postoperative follow-up magnetic resonance imaging or computed tomographic scan of the temporal bone.

RESULTS

Approximately 13 patients (72%) were female subjects, and 5 (28%) were male subjects. Mean age was 54 years, and follow-up was 73 months. 17 (94%) of 18 patients presented with facial paresis or paralysis. Facial twitching was present in 10 (56%) of 18 cases. Four patients (22%) presented with hearing loss. Facial nerve function was House-Brackmann grade I/II in 7(38%), III/IV in 5 (28%), and V/VI in 6 (34%) patients, respectively. Approximately 13 patients (72%) underwent middle fossa craniotomy for excision or decompression of their hemangiomas, and 2 (11%) underwent translabyrinthine removal. The facial nerve was preserved in 11 (73%) of 15 patients and was excised and grafted in 4 (27%) of 15. Recovery to a House-Brackmann grade I/II was seen in 8 (72%) of 11 patients in whom the integrity of the facial nerve was preserved. In the surgical group, hearing remained stable in 64% of hearing preservation cases and worsened in 38%. Facial function remained stable in the nonsurgical group.

CONCLUSION

Geniculate ganglion hemangiomas are rare vascular malformations that produce facial paralysis despite their relative small size at presentation. When possible, excision with neural preservation yields better long-term facial function. Recurrences are rare.