Meningiomas intrinsic to the geniculate ganglion.

Objective: To present the clinical, surgical and histopathological manifestations of meningioma intrinsic to the geniculate ganglion.

Study Design: Retrospective study of outcome.

Setting: Three private tertiary and one university (otology/neurotology) referral centers.

Patients: Six patients with cranial nerve VII paresis underwent magnetic resonance imaging and/or high-resolution computed tomography for subsequently histologically proven intrinsic meningioma of the geniculate ganglion. An additional six cases were identified in the literature. Most patients were female and ranged in age from 5 to 40 years.

Intervention: Total tumor removal via middle fossa and mastoid exposures followed by cable graft VII-VII neuroanastomosis.

Main Outcome Measure: Meningioma can occur intrinsic to the geniculate ganglion and produces gradual VIIth nerve paresis as its first symptom. Other sites of predilection may occur extrinsically within the temporal bone or along intracranial venous sinuses at sites of arachnoid villi.

Results: Hearing was maintained in each patient, and postoperative House-Brackmann grade III-V facial nerve function was achieved.

Conclusions: Intrinsic meningiomas of the geniculate ganglion rarely occur. However, this entity should be included in the differential diagnosis of a slowly progressive VIIth nerve paresis, especially in young females. Surgical removal and cable graft VII-VII neuroanastomosis is the treatment of choice. Long-term follow-up should be maintained because of the potential for von Recklinghausen's disease.