Facial nerve management in temporal bone hemangiomas

Eight patients with intratemporal hemangiomas involving the facial nerve are reported to present their symptoms, pathology, surgical management, and results. These unusual tumors have a predilection to involve the facial nerve, usually at the geniculate ganglion, internal auditory canal, or middle ear. Patients presented with facial palsy that was sudden, gradual in onset, recurrent, or associated with hemifacial spasm. Symptoms often progressed for years before the diagnosis was made. In two cases the tumor caused bony remodeling with an expansile honeycombed appearance, but no neoplastic production of bone. The facial nerve was comprised either by tumor compression or nerve invasion, as seen in two of our patients. Complete removal of the tumor and rehabilitation of the facial nerve function was attained in each case. Because of the destructive nature of these benign tumors, intratemporal facial nerve grafting was required in five of the eight cases. Results of facial nerve repair were good except in cases of long-standing facial dysfunction.