Facial Nerve Hemangioma in the Internal Auditory Canal: A Rare Localization and Therapeutic Challenge.

OBJECTIVE: Facial nerve hemangiomas (FNHs) are rare vascular tumors that often mimic other facial nerve disorders, making diagnosis and management challenging. This report highlights a case of FNH in the internal auditory canal (IAC) successfully treated via a translabyrinthine approach. CASE PRESENTATION: A 64-year-old female patient with a history of squamous cell carcinoma of the tongue presented with progressive left-sided peripheral facial paralysis (House-Brackmann Grade IV), associated with ipsilateral hearing loss and vertigo. MRI revealed a nodular lesion in the IAC with imaging features suggestive of a vascular origin. Due to symptom severity, surgical excision was performed using a translabyrinthine approach. Intraoperatively, a vascular lesion compressing but not infiltrating the facial nerve was excised, and histopathology confirmed FNH. RESULTS: The patient showed significant postoperative improvement, with facial nerve function improving to House-Brackmann Grade II at 6 months. CONCLUSION: Early recognition and surgical intervention for symptomatic FNHs can prevent further neurological impairment. The translabyrinthine approach offers effective tumor removal while preserving facial nerve integrity.