BACKGROUND AND OBJECTIVES: Anatomical knowledge of microsurgical anatomy of the perigeniculate ganglion area is essential to the exploration of the facial nerve via translabyrinthine approach or middle fossa approach. This study was designed to investigate the surgical anatomy of the perigeniculate ganglion area of the facial nerve in view of translabyrinthine and middle fossa approach. MATERIALS AND METHOD: We dissected 15 human cadaveric temporal bones under a microscope and measured the lengths of the proximal part of tympanic segment, the labyrinthine segment, and the angle between the tympanic segment and the labyrinthine segment in the view of translabyrinthine approach. We dissected 20 human temporal bones under a microscope using a middle fossa approach, and measured the angle between the lines drawn from the malleus head to the vertical crest and from the malleus head to the geniculate ganglion, and the distance from the malleus head to the geniculate ganglion. RESULTS: The distance of facial nerve from the cochleariform process to the geniculate ganglion was 3.8+/-0.7 mm. The length of the labyrinthine segment of facial nerve was 4+/-0.8 mm. The angle between the tympanic segment and the labyrinthine segment in the view of translabyrinthine approach was 26+/-5degrees. The angles between the lines drawn from the malleus head to the vertical crest and from the malleus head to the geniculate ganglion, and the distance from the malleus head to the geniculate ganglion were found to be 23+/-2degreesand 6.5+/-0.3 mm, respectively. CONCLUSION: Precise knowledge about the microsurgical anatomy of the perigeniculate ganglion area of facial nerve is imperative for facial nerve decompression by a translabyrinthine and middle fossa approach.
Cadaver ; Cranial Fossa, Middle ; Decompression ; Facial Nerve* ; Ganglion Cysts* ; Geniculate Ganglion ; Head ; Humans ; Malleus ; Temporal Bone

The present study was undertaken to analyze the radiologic findings of intratemporal and extratemporal schwannoma (ITS & ETS). We retrospectively reviewed the CT (9 cases), MR (3 cases) and medical records of 10 facial schwannoma patients. After classifying these into ITS and ETS, radiologic and clinical findings were analyzed. The most common clinical manifestations were facial nerve dysfunction (6/6 cases, 100%) and hearing impairment (5/6 cases, 83.3%) in ITS and parotid mass (4/4 cases, 100%) in ETS. Geniculate ganglion (GG) was the most commonly involved segment of ITS (5/6 cases, 83.5%). On CT, ITS arising in GG (4 cases) showed erosion of the petrous bone (4 cases), cochlea (3 cases), lateral semicircular canal (1 case) and ossicles (3 cases). ITS arising in the mastoid segment (1 case) showed the destruction of the jugular plate and external auditory canal wall. All three ITS in which MRI was performed showed iso- to hypointensity on T1WI, hyperintensity on T2WI and well-enhanced on post-enhanced T1WI. ETS showed various findings, but all four ETS were located in the posterolateral portion of the retromandibular vein and extended toward the stylomastoid foramen. In conclusion, ITS shows the schwannoma on MR. ETS shows various findings. However, if the tumor is located along the extratemporal facial nerve course, then facial schwannoma may be suspected.
Adult ; Cranial Nerve Neoplasms/diagnosis* ; Facial Nerve* ; Female ; Geniculate Ganglion/radiography ; Geniculate Ganglion/pathology ; Human ; Magnetic Resonance Imaging* ; Male ; Middle Age ; Neurilemmoma/diagnosis* ; Tomography, X-Ray Computed*

PURPOSE: To evaluate the usefulness of quantitative analysis of the facial nerve using contrast-enhanced three-dimensional (CE 3D) fluid-attenuated inversion recovery-volume isotopic turbo spin echo acquisition (FLAIR-VISTA) for the diagnosis of Bell's palsy in pediatric patients. MATERIALS AND METHODS: Twelve patients (24 nerves) with unilateral acute facial nerve palsy underwent MRI from March 2014 through March 2015. The unaffected sides were included as a control group. First, for quantitative analysis, the signal intensity (SI) and relative SI (RSI) for canalicular, labyrinthine, geniculate ganglion, tympanic, and mastoid segments of the facial nerve on CE 3D FLAIR images were measured using regions of interest (ROI). Second, CE 3D FLAIR and CE T1-SE images were analyzed to compare their diagnostic performance by visual assessment (VA). The sensitivity, specificity, and accuracy of RSI measurement and VA were compared. RESULTS: The absolute SI of canalicular and mastoid segments and the sum of the five mean SI (total SI) were higher in the palsy group than in the control group, but with no significant differences. The RSI of the canalicular segment and the total SI were significantly correlated with the symptomatic side (P = 0.028 and 0.015). In 11/12 (91.6%) patients, the RSI of total SI resulted in accurate detection of the affected side. The sensitivity, specificity, and accuracy for detecting Bell's palsy were higher with RSI measurement than with VA of CE 3D FLAIR images, while those with VA of CE T1-SE images were higher than those with VA of CE 3D FLAIR images. CONCLUSION: Quantitative analysis of the facial nerve using CE 3D FLAIR imaging can be useful for increasing the diagnostic performance in children with Bell's palsy when difficult to diagnose using VA alone. With regard to VA, the diagnostic performance of CE T1-SE imaging is superior to that of CE 3D FLAIR imaging in children. Further studies including larger populations are necessary.
Bell Palsy* ; Child ; Diagnosis ; Facial Nerve* ; Geniculate Ganglion ; Humans ; Magnetic Resonance Imaging ; Mastoid ; Paralysis ; Sensitivity and Specificity

Ramsay Hunt Syndrome was initially described by Ramsay Hunt in 1907 as herpes zoster of the geniculate ganglion. The frequency of RHS in patients with herpes zoster has been calculated to be about 1%. RHS affects mostly adults; however a small number of children with herpes zoster oticus have been reported. We describe a case of RHS in a healthy 39/12-year-old boy. A complete peripheral facial palsy on the left side was noted as well as vesicles of herpes zoster type on the pinna of the same side. The analysis of sera confirmed the clinical diagnosis of RHS with a positive IgG-ELISA antibody titier. Treatment of acyclovir was tried for 7 days, starting 2 days after facial palsy was objerved. In addition, oral prednisolon, divided into two doses per day, was administered for 5 days and then tapered to zero over the following 10 days. Complete recovery observed after 1 month.
Acyclovir ; Adult ; Child ; Diagnosis ; Facial Paralysis ; Geniculate Ganglion ; Herpes Zoster ; Herpes Zoster Oticus ; Humans ; Male

As an attempt to better understand the microanatomy during transpetrosal surgery and to determine the limitation of extradural middle fossa approach, 16 adults human cadaveric skull base speciments were dissected at the region of petroclivus and posterior cavernous sinus. The important landmarks chosen for this study included the following: a petrosigmoid intersection, arcuate eminence, foramen spinosum, foramen ovale, hiatus of greater superficial petrosal nerve (GSPN), porus acousticus internus, geniculate ganglion, cochlea and petrous portion of internal carotid artery(ICA). The resultant data are as follows: the length between the petrosigmoid intersection and the arcuate eminence was 23.1mm+/-1.9(20.1-26.5). The depth covering geniculate ganglion was 1.3mm+/-0.3(0.8-1.8). The length between the geniculate ganglion and the hiatus of GSPN as well as cochlea were 4.6mm+/-1.1(3.5-7.1) and 0.9mm+/-0.2(0.7-1.2) respectively. The whole length of the GSPN exposed the middle cranial fossa was 11.0mm+/-0.8(9.3-12.5). The diameter f the petrous portion of ICA was 5.9mm+/-0.2(5.5-6.4). The length of the horizontal segment of the petrous ICA that can be exposed for anastomosis was 10.8mm+/-0.9(9.0-12.3). The distance between geniculate ganglion and porus acousticus showed a sighificant difference in all measurements to be compared with right and left side(p<0.05). The angle between the internal acoustic meatus and GSPN correlated inversely to the length of horizontal segment of pertrous ICA(r=-0.54, p<0.05). Morphometric analysis and their correlation between bony landmarks and structures within the pyramid helped to decide the angle and direction from which bone removal could be accomplished more safely during transpetrosal surgery, including the middle fossa approach.
Acoustics ; Adult ; Cadaver ; Cavernous Sinus ; Cochlea ; Cranial Fossa, Middle* ; Foramen Ovale ; Geniculate Ganglion ; Humans ; Skull Base

Cranial Nerve Neoplasms ; pathology ; Geniculate Ganglion ; pathology ; Humans ; Meningeal Neoplasms ; pathology ; Meningioma ; pathology

Schwannoma is a benign neoplasm of the nerve sheath and is the most common neoplasm of the internal auditory canal (IAC) and cerebellopontine angle. A dumbbell-shaped schwannoma is defined as a mass with two bulbous segments, one in the IAC fundus and the other in the membranous labyrinth of the inner ear or the geniculate ganglion of the facial nerve connected to labyrinth segment. This kind of schwannoma should not be missed because it can affect the type of surgery and so the prognosis of the patient. We present one case of dumbbell-shaped facial nerve schwannoma which was completely excised without any complication.
Cerebellopontine Angle ; Cranial Fossa, Middle ; Ear, Inner ; Facial Nerve ; Geniculate Ganglion ; Humans ; Neurilemmoma ; Prognosis

PURPOSE: To analyze the characteristics of CT and MRI findings of facial nerve schwannoma in ten patients. MATERIALS AND METHODS: Ten patients with pathologically confirmed facial nerve schwannoma, underwent physical and radiologic examination. The latter involved MRI in all ten and CT scanning in six. We analyzed the location (epicenter), extent and number of involved segments of tumors, tumor morphology, and changes in adjacent bony structures. RESULTS: The major symptoms of facial nerve schwannoma were facial nerve paralysis in seven cases and hearing loss in six. Epicenters were detected at the intraparotid portion in five cases, the intracanalicular portion in two, the cisternal portion in one, and the intratemporal portion in two. The segment most frequently involved was the mastoid (n=6), followed by the parotid (n=5), intracanalicular (n=4), cisternal (n=2), the labyrinthine/geniculate ganglion (n=2) and the tympanic segment (n=1). Tumors affected two segments of the facial nerve in eight cases, only one segment in one, and four continuous segments in one. Morphologically, tumors were ice-cream cone shaped in the cisternal segment tumor (1/1), cone shaped in intracanalicular tumors (2/2), oval shaped in geniculate ganglion tumors (1/1), club shaped in intraparotid tumors (5/5) and bead shaped in the diffuse-type tumor (1/1). Changes in adjacent bony structures involved widening of the stylomastoid foramen in intraparotid tumors (5/5), widening of the internal auditary canal in intracanalicular and cisternal tumors (3/3), bony erosion of the geniculate fossa in geniculate ganglion tumors (2/2), and widening of the facial nerve canal in intratemporal and intraparotid tumors (6/6). CONCLUSION: The characteristic location, shape and change in adjacent bony structures revealed by facial schwannomas on CT and MR examination lead to correct diagnosis.
Diagnosis ; Facial Nerve* ; Ganglion Cysts ; Geniculate Ganglion ; Hearing Loss ; Humans ; Magnetic Resonance Imaging* ; Mastoid ; Neurilemmoma ; Paralysis ; Tomography, X-Ray Computed

OBJECTIVE: Several conservative treatments have been tried in peripheral facial nerve paralysis, because 80% of patients recover spontaneously. Surgical decompression may be helpful to the residual, medically intractable patients. We present here our experiences of facial nerve decompression via middle fossa approach, which seems to be one of good surgical therapeutic options for medically refractory peripheral facial nerve paralysis. METHOD:Three cases of medically intractable peripheral type facial paralysis were microscopically operated via middle cranial fossa approach to decompress the labyrinthine segment of the facial nerve and geniculate ganglion by searching landmarks of middle meningeal artery, greater superficial petrosal nerve and facial hiatus. RESULTS: After operation, two cases of Bell's palsy improved substantially and one case of post-traumatic facial paralysis improved partially. CONCLUSION: This report is presented to describe the surgical facial nerve decompression via middle fossa for early control of peripheral type facial paralysis. Surgical decompression of edematous peripherally paralysed facial nerve could be preferred to conservative treatment in some patients although more surgical experience should be required.
Bell Palsy ; Cranial Fossa, Middle ; Decompression* ; Decompression, Surgical ; Facial Nerve* ; Facial Paralysis ; Geniculate Ganglion ; Humans ; Meningeal Arteries ; Paralysis

PURPOSE: To evaluate the usefulness of 3 dimensional-volume MR imaging technique for demonstrating the facial nerves and to describe MR findings in facial palsy patients and evaluate the significance of facial nerve enhancement. MATERIALS AND METHODS: We reviewed the MR images of facial nerves obtained with 3 Dimensional-volume imaging technique before and after intravenous administration of Gadopentetate dimeglumine in 13 cases who had facial paralysis and 33 cases who had no facial palsy. And we analyzed the detectabilty of anatomical segments of intratemporal facial nerves and facial nerve enhancement. RESULTS: When the 3 Dimensional-volume MR images of 46 nerves were analyzed subjectively, the nerve courses of 43(93%) of 46 nerves were effectively demonstrated on 3 Dimensional-volume MR images. Internal acoustic canal portions and geniculate ganglion of facial nerve were well visualized on axial images and tympanic and mastold segments were well depicted on oblique sagittal images. 10 of 13 patients(77%) were visibly enhanced along at least one segment of the facial nerve with swelling or thickening, and nerves of 8 of normal 33 cases(24%) were enhanced without thickening or swelling. CONCLUSION: MR findings of facial nerve paralysis is asymmetrical thickening of facial nerve with contrast enhancement. The 3 Dimensional-volume MR imaging technique should be a useful study for the evaluation of intratemporal facial nerve disease.
Acoustics ; Administration, Intravenous ; Facial Nerve Diseases ; Facial Nerve* ; Facial Paralysis ; Gadolinium DTPA ; Geniculate Ganglion ; Humans ; Magnetic Resonance Imaging* ; Paralysis