Management of Geniculate Ganglion Hemangiomas

Oldenburg, Michael S.; Carlson, Matthew L.; Abel, Kathryn M. Van; Driscoll, Colin L. W.; Link, Michael J.

doi:10.1097/mao.0000000000000891

Cited by 18 publications

(16 citation statements)

References 32 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Meanwhile, Matthies and Samii found that 17% of patients with vestibular schwannoma had PFP. Peripheral facial palsy was also reported in nearly all cases (113 of 120 [94.2%]) of facial nerve hemangioma reviewed by Oldenburg et al and as an isolated symptom in more than 50% of cases. As reviewed recently by Bacrorn et al, numerous other diseases can mimic BP, a substantial proportion of which (4 of 25 [16.0%]) involve the parotid gland.…”

Section: Discussionmentioning

confidence: 87%

Incidence of Underlying Abnormal Findings on Routine Magnetic Resonance Imaging for Bell Palsy

et al. 2023

View full text Add to dashboard Cite

ImportanceThere is no consensus on the benefits of routine magnetic resonance imaging (MRI) of the facial nerve in patients with suspected idiopathic peripheral facial palsy (PFP) (ie, Bell palsy [BP]).ObjectivesTo estimate the proportion of adult patients in whom MRI led to correction of an initial clinical diagnosis of BP; to determine the proportion of patients with confirmed BP who had MRI evidence of facial nerve neuritis without secondary lesions; and to identify factors associated with secondary (nonidiopathic) PFP at initial presentation and 1 month later.Design, Setting, and ParticipantsThis retrospective multicenter cohort study analyzed the clinical and radiological data of 120 patients initially diagnosed with suspected BP from January 1, 2018, to April 30, 2022, at the emergency department of 3 tertiary referral centers in France.InterventionsAll patients screened for clinically suspected BP underwent an MRI of the entire facial nerve with a double-blind reading of all images.Main Outcomes and MeasuresThe proportion of patients in whom MRI led to a correction of the initial diagnosis of BP (any condition other than BP, including potentially life-threating conditions) and results of contrast enhancement of the facial nerve were described.ResultsAmong the 120 patients initially diagnosed with suspected BP, 64 (53.3%) were men, and the mean (SD) age was 51 (18) years. Magnetic resonance imaging of the facial nerve led to a correction of the diagnosis in 8 patients (6.7%); among them, potentially life-threatening conditions that required changes in treatment were identified in 3 (37.5%). The MRI confirmed the diagnosis of BP in 112 patients (93.3%), among whom 106 (94.6%) showed evidence of facial nerve neuritis on the affected side (hypersignal on gadolinium-enhanced T1-weighted images). This was the only objective sign confirming the idiopathic nature of PFP.Conclusions and RelevanceThese preliminary results suggest the added value of the routine use of facial nerve MRI in suspected cases of BP. Multicentered international prospective studies should be organized to confirm these results.

show abstract

Section: Discussionmentioning

confidence: 87%

Incidence of Underlying Abnormal Findings on Routine Magnetic Resonance Imaging for Bell Palsy

et al. 2023

View full text Add to dashboard Cite

show abstract

“…Hearing loss and otalgia were less common presentation symptoms, found in 15% and 2% of reported cases, respectively. 2 There is disagreement regarding optimal management of GGH, due in part to the rarity of these lesions. Geniculate ganglion hemangiomas represent 0.7% of all temporal bone tumors, 3 with approximately 130 unique cases reported in the literature.…”

Section: Discussionmentioning

confidence: 99%

Geniculate Ganglion Hemangioma Visualized Through Perforated Tympanic Membrane

Riutta

Benson

2020

Ear Nose Throat J

View full text Add to dashboard Cite

A 56-year-old woman presented with complaints of otalgia with left-sided hearing loss. She reported left tympanic membrane perforation and chronic ear infections secondary to traumatic injury as a child. She also had a history of intermittent otorrhea in the year prior to being seen at the clinic. Tympanometry of the left ear revealed restricted eardrum mobility and large equivalent ear canal volume. Audiometric testing showed a mild sensorineural hearing loss in the right ear and moderately severe mixed hearing loss in the left ear. The patient had a speech reception threshold of 45 dB hearing level (HL) and 88% word recognition at 80 dB HL with her left ear. An otoendoscope was used to examine the patient's left external auditory canal and tympanic membrane, then advanced beyond the annulus and through the tympanic membrane perforation to the middle ear itself. A mass was seen superior to the eustachian tube opening and medial to the manubrium of the malleus (Figure 1). Subsequent computed tomography (CT) imaging revealed abnormal demineralization and lucency in the region of the facial nerve (FN) geniculate ganglion and along the rostral roof of the middle ear (Figure 2A and B). The location of the abnormality visualized by CT corresponded to the location of the mass observed during middle ear exploration. Magnetic resonance imaging (MRI) revealed an enhancing lesion present in the left FN geniculate ganglion region measuring 6 to 7 mm ( Figure 2C and D). The pattern of demineralization present in the CT scan, together with the enhancing lesion observed by MRI, suggested FN hemangioma of the geniculate ganglion. Notably, the patient did not have any symptoms of FN weakness. No surgical intervention was taken; MRI follow-up 6 months later revealed no change in size of the hemangioma. DiscussionGeniculate ganglion hemangiomas (GGHs) are rare, benign vascular tumors of the FN involving the geniculate ganglion. 1 Facial nerve weakness is the most common presentation symptom of these tumors; a systematic review by Oldenburg et al found patients presented with FN palsy in 94% of GGH reported in the literature. Hearing loss and otalgia were less common presentation symptoms, found in 15% and 2% of reported cases, respectively. 2 There is disagreement regarding optimal management of GGH, due in part to the rarity of these lesions. Geniculate ganglion hemangiomas represent 0.7% of all temporal bone tumors, 3 with approximately 130 unique cases reported in the literature. 2,4 The limited research available suggests better outcomes when intervention is taken Figure 1. Otoscopy reveals mass in the middle ear (white arrow). ET indicates eustachian tube opening; JN, Jacobson's nerve; M, manubriumof the malleus.

show abstract

“…12 In contrast to facial nerve schwannoma, geniculate ganglion hemangioma is classically associated with more advanced nerve symptoms (including spasm, recurrent palsy with intervals of recovery, or progressive facial paralysis) out of proportion to tumor size. 13 Vertigo and pulsatile tinnitus are rare but may result from invasion of the labyrinth. 14 Facial nerve hemangiomas are typically T1 iso/hypointense, T2 hyperintense, and heterogeneously enhanced on MRI.…”

Section: Discussionmentioning

confidence: 99%

Expansile Traumatic Neuroma of the Intratemporal Facial Nerve

et al. 2019

View full text Add to dashboard Cite

Objectives To present a rare case of traumatic facial neuroma involving the geniculate ganglion and review relevant literature. Patient Thirty-year-old man. Intervention Microsurgical resection via combined mastoid-middle fossa approach with great auricular nerve interpositional graft. Main Outcome Measures Patient demographics and pre- and postoperative facial nerve function. Results A 30-year-old man with a reported history of prior Bell's palsy developed progressive complete (House–Brackmann VI) right facial paralysis following blunt trauma. Imaging was strongly suggestive of a geniculate ganglion hemangioma. As the patient had no spontaneous improvement in his poor facial function over the course of 9 months, he underwent resection of the facial nerve lesion with great auricular nerve graft interposition via a combined mastoid-middle fossa approach. Histopathology demonstrated disorganized fascicles, with axonal clustering reminiscent of sprouting/regeneration following trauma. No cellular proliferation or vascular malformation was present. Conclusion Traumatic facial nerve neuromas can occur following temporal bone trauma and can closely mimic primary facial nerve tumors. Akin to the management of geniculate ganglion hemangioma and schwannoma, preoperative facial function largely dictates if and when surgery should be pursued.

show abstract

Management of Geniculate Ganglion Hemangiomas

Abstract: GGHs are rare benign vascular malformations that present with progressive FN palsy. In most patients, early surgical intervention should be considered since shorter duration of FN paralysis and anatomical preservation of the FN are significant predictors of final FN outcome.

Cited by 18 publications

References 32 publications

Incidence of Underlying Abnormal Findings on Routine Magnetic Resonance Imaging for Bell Palsy

Incidence of Underlying Abnormal Findings on Routine Magnetic Resonance Imaging for Bell Palsy

Geniculate Ganglion Hemangioma Visualized Through Perforated Tympanic Membrane

Expansile Traumatic Neuroma of the Intratemporal Facial Nerve

Contact Info

Product

Resources

About