Hemangiomas of the geniculate ganglion

Objective: To describe the presentation, evaluation, and management of patients with geniculate ganglion hemangioma. Study Design: Retrospective case review. Setting: Tertiary-care academic medical center. Patients: Six patients with hemangiomas of the geniculate ganglion, evaluated and managed at a single institution. Intervention: All patients underwent imaging and follow-up, with five of the patients undergoing operative intervention. Main Outcome Measures: Tumor size and extent, facial nerve and hearing function, histopathologic findings, and complications are discussed as a function of observation versus microsurgical excision. Results: Six patients with ossifying hemangiomas of the geniculate ganglion were evaluated at a single institution over a 10-year period. These patients underwent operative intervention when their facial nerve function began to decline. Hearing was preserved in five of the six cases. Resection and grafting of the facial nerve was required in five of six cases. Two of the six cases were found to have histologic evidence of facial nerve infiltration on pathologic examination. Conclusion: The majority of these tumors infiltrated the facial nerve and could not be completely removed without excision of the nerve itself. Based on this experience, it would seem reasonable to defer surgical excision until facial nerve function has declined to grade 3 or worse. Whether earlier subtotal excision would result in better outcomes or not remains unanswered. This study presents several complicated scenarios that illustrate the difficulty of clinical decision-making in this disease. Associated clinical dilemmas and controversies are discussed.