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.