Management and Outcomes of Facial Nerve Hemangiomas: A Systematic Review of the Literature

Abstract

Objectives: To conduct a systematic review of facial nerve hemangiomas (FNH), focusing on patient characteristics, management options, and treatment outcomes. Design: A systematic review was performed following PRISMA guidelines, utilizing PubMed, EMBASE, Scopus, and Cochrane databases from inception to December 31st, 2022. Setting: Literature sourced from various databases providing information on FNH cases. Participants: A total of 176 patients with FNH were included in the study, identified from 40 articles meeting inclusion criteria. Main Outcome Measures: Patient demographics, lesion characteristics, pre-operative symptoms, surgical approaches, and post-operative outcomes, including House-Brackmann (HB) Grades. Results: Among the 1682 initially identified articles, 40 were included in the final review. From these, a total of 176 patients (mean age=42.7±12.8, 51.1% male) were included for analysis. Bivariate analysis showed that patients with longer pre-operative symptom duration and facial nerve sacrifice had significantly greater post-operative HB Grades (p<.001). Additionally, a strong positive correlation was observed between pre- and post-operative HB Grades (Spearman’s rho=.649). Multivariable linear regression analysis showed that both facial nerve sacrifice (β=0.86, 95%CI:0.38-1.34;p<.001) and greater pre-operative HB Grades (β=0.36,95% CI:0.20-0.53;p<.001) were associated with significantly greater post-operative HB Grades, but pre-operative symptom duration did not persist as a significant predictor of post-operative HB Grades. Conclusions: Facial nerve hemangiomas are rare lesions of the skull base affecting the temporal bone. Our findings highlight the role of pre-operative facial nerve function and intraoperative preservation of the facial nerve in predicting post-operative outcomes. Timely resection of lesions that prioritizes facial nerve preservation is critical to achieving optimal patient outcomes.