Presentation
Left sided facial weakness.
Patient Data
Unenhanced CT of the temporal bones demonstrates an ill-defined lucency centered at the first genu of the facial nerve. The bone is irregular. The facial nerve canal is expanded both in the labyrinthine and tympanic segments.
There is a 14.5mm x 14mm x 8mm avidly enhancing mass lesion along the anterior margin of the left petrous apex, demonstrating continuity with the genu of the left facial nerve canal. The lesion causes mild impression on the adjacent left inferior temporal gyrus without definite associated cortical or subcortical FLAIR signal change.
No remote intra- or extra-axial mass lesions, acute hemorrhages or collections. The internal auditory canals as well as the vestibulo-cochlear nerve complexes appear unremarkable. No regions of remote abnormal parenchymal or meningeal enhancement.
Conclusion:
Based on the current MRI imaging morphology and the bony change seen on CT, the enhancing mass along the anterior margin of the left petrous apex likely represents an intra-osseous facial nerve hemangioma.
MICROSCOPIC DESCRIPTION: The sections show an unremarkable nerve fasciculus which terminates in a circumscribed lesion which consists of viable bone with prominent thin-walled ectatic blood vessels within intertrabecular spaces. These are lined by unremarkable endothelium. Stromal connective tissue is unremarkable. The features are of cavernous hemangioma. No evidence of malignancy is seen.
DIAGNOSIS: Left facial nerve tumor: Intraosseous cavernous hemangioma.
Case Discussion
This case illustrates a facial nerve hemangioma, a rare vascular malformation involving the facial nerve. This entity is now called as venous vascular malformations of the facial nerve, as it does not appear to have clinical course, or histological features of hemangiomas.
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