Facial Nerve Management in Geniculate Ganglion Hemangiomas

Abstract

Background: Despite increasing clinical experience with geniculate ganglion hemangiomas (GGH), optimal management of the facial nerve (FN) is still debated. We aim to compare results following decompression and subtotal tumor resection (STR) versus gross-total tumor resection (GTR) and nerve grafting with regards to FN and tumor outcomes in patients with GGH. Methods: Retrospective review of all patients with GGH from 1992 to 2012 at a single tertiary care facility. Primary outcome measures include FN function using the House-Brackmann (HB) scale and tumor control as measured by serial MRIs. Results: Six patients met criteria (3M:3F, average age 38). Three patients underwent GTR and interposition grafting of the FN. Three patients underwent FN decompression with nerve preservation. Of these patients, one had GTR and two had STR in place of FN sacrifice. After excision and grafting, two patients continued to have HB grade 6 function and one patient, preoperatively a grade 4, slowly improved postoperatively from grade 6 to grade 5. In contrast, decompression resulted in improvement from HB grade 6 to 3 in one patient and grade 3 to 2 in two patients. There were no recurrences in any patient with radiological follow-up ranging from 3 to 168 months. Conclusion: Decompression and preservation of the FN in patients with GGH resulted in improved postoperative FN function compared with FN sacrifice and interposition graft. No recurrences were seen in either group.