title: Lateral skull base approaches in the management of benign parapharyngeal space tumors.
abstract: OBJECTIVE
  To evaluate the role of lateral skull base approaches in the management of benign parapharyngeal space tumors and to propose an algorithm for their surgical approach.
  
  
  METHODS
  Retrospective study of patients with benign parapharyngeal space tumors. The clinical features, radiology and preoperative management of skull base neurovasculature, the surgical approaches and overall results were recorded.
  
  
  RESULTS
  46 patients presented with 48 tumors. 12 were prestyloid and 36 poststyloid. 19 (39.6%) tumors were paragangliomas, 15 (31.25%) were schwannomas and 11 (23%) were pleomorphic adenomas. Preoperative embolization was performed in 19, stenting of the internal carotid artery in 4 and permanent balloon occlusion in 2 patients. 19 tumors were approached by the transcervical, 13 by transcervical-transparotid, 5 by transcervical-transmastoid, 6, 1 and 2 tumors by the infratemporal fossa approach types A, B and D, respectively. Total radical tumor removal was achieved in 46 (96%) of the cases.
  
  
  CONCLUSIONS
  Lateral skull base approaches have an advantage over other approaches in the management of benign tumors of the parapharyngeal space due to the fact that they provide excellent exposure with less morbidity. The use of microscope combined with bipolar cautery reduces morbidity. Stenting of internal carotid artery gives a chance for complete tumor removal with arterial preservation.
authors.affiliation: Department of Otology & Skull Base Surgery, Gruppo Otologico, Piacenza-Rome, Italy. Electronic address: sampathcp@yahoo.co.in.
authors.forename: Sampath Chandra
authors.initials: SC
authors.lastname: Prasad
authors.affiliation: Department of Otology & Skull Base Surgery, Gruppo Otologico, Piacenza-Rome, Italy.
authors.forename: Enrico
authors.initials: E
authors.lastname: Piccirillo
authors.affiliation: Department of Otorhinolaryngology and Head and Neck Surgery, Faculty Hospital Motol, Charles University, Prague, Czech Republic.
authors.forename: Martin
authors.initials: M
authors.lastname: Chovanec
authors.affiliation: Unit of Otolaryngology and Middle Ear Surgery, University of Parma, Italy.
authors.forename: Claudio
authors.initials: C
authors.lastname: La Melia
authors.affiliation: Department of Otology & Skull Base Surgery, Gruppo Otologico, Piacenza-Rome, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: De Donato
authors.affiliation: Department of Otology & Skull Base Surgery, Gruppo Otologico, Piacenza-Rome, Italy; Otolaryngology Clinic, University of Chieti, Italy.
authors.forename: Mario
authors.initials: M
authors.lastname: Sanna
mesh_terms: D008949:Adenoma, Pleomorphic / Q000601:surgery*; D000328:Adult; D002345:Carotid Body Tumor / Q000601:surgery*; D015331:Cohort Studies; D003390:Cranial Nerve Neoplasms / Q000601:surgery*; D005260:Female; D006258:Head and Neck Neoplasms / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009333:Neck; D009442:Neurilemmoma / Q000601:surgery*; D009455:Neurofibroma / Q000601:surgery*; D010235:Paraganglioma / Q000601:surgery; D010614:Pharynx; D012189:Retrospective Studies; D012468:Salivary Gland Neoplasms / Q000601:surgery*; D019291:Skull Base
keywords: Infratemporal fossa approaches (ITFA); Internal carotid artery (ICA); Lateral skull base surgery; Lower cranial nerves (LCN); Parapharyngeal space (PPS); Parapharyngeal space tumors (PPST)