Standardised method of selecting surgical approaches to benign parapharyngeal space tumours, based on pre-operative images

Abstract

Many approaches to the parapharyngeal space have been reported. However, few reports describe parapharyngeal space tumours and the best surgical approach to these tumours. We retrospectively examined the surgical approaches we used to resect 22 parapharyngeal space tumours. In order to determine the best surgical approach for each tumour, we first subdivided the parapharyngeal space into six compartments, based on anatomical landmarks seen on computed tomography and/or magnetic resonance imaging scans. We then determined the location of each tumour relative to these six parapharyngeal space compartments. In our series of cases, we found that large tumours spanning the superior portion of the parapharyngeal space could be completely removed through a skull base approach. To remove a large tumour in the middle and inferior portion of the parapharyngeal space, a transparotid approach was the most suitable. Finally, a tumour in the inferior portion of the parapharyngeal space was best accessed through a transcervical approach.

Transcervical Approach: Is It Enough for Parapharyngeal Tumors Excision? A Report of Five Cases

“…Several surgical approaches have been designed to facilitate removing parapharyngeal space tumors. Consistent with other reports, transverse cervical approach was our favorable technique [3][4][5]9,17,18 . Transcervical approach for removal of the parapharyngeal space tumors was first described in 1955 19 .…”

Contemporary management of primary parapharyngeal space tumors

“…To remove a large tumor in the middle and inferior portion of the PPS, a transparotid approach is the most suitable. Finally, a tumor in the inferior portion of the PPS is best accessed through a transcervical approach . However, the vast majority of benign tumors of the prestyloid space, regardless of their superior extension, can be resected by a transcervical, transparotid, or combined approach.…”

Surgical anatomy of the parapharyngeal space: Multiperspective, quantification‐based study

“…For the same reasons, whenever imaging and/or cytology suggests the benign nature of a PPT, a "wait and see" policy may also be adopted in asymptomatic or slow-growing lesions, especially in patients with severe comorbidities. 5,[12][13][14][15][16][17] The purpose of this preclinical study is to compare the main surgical approaches to the PPS based on systematic cadaver dissection and navigation-based quantification of surgical corridors. [5][6][7][8][9] In addition, several technical refinements, such as endoscope-assisted dissection, intraoperative neuromonitoring, and debrider-assisted cavitation, were introduced to minimize surgical morbidity without affecting radicality of resection.…”

“…4,10,11 Although some attempts have been made to systematize the choice of the surgical approach in relation to the target, an objective description of advantages and limitations of the different surgical routes to PPS is lacking. 5,[12][13][14][15][16][17] The purpose of this preclinical study is to compare the main surgical approaches to the PPS based on systematic cadaver dissection and navigation-based quantification of surgical corridors.…”