A patient with a progressive peripheral facial paralyses should be considered to have a tumor involved the facial nerve until proved otherwise. Haemangiomas of the temporal bone are uncommon and the present study discusses pathology, clinical presentation and therapeutic management of a tumor located at the geniculate ganglion. Complete surgical removal by the middle fossa approach is the treatment of choice with adequate margins and preservation of adjacent structures when it is oncologically possible. The surgeon must be familiar with all aspects of facial nerve repair.

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