Microsurgery in primary tumours of the parapharyngeal space: observational retrospective analysis of a series of consecutive cases.

Antonio Mazzoni, Leonardo Franz, Elisabetta Zanoletti
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Abstract

Objective: To investigate safety and efficacy of the microsurgical approach to parapharyngeal space (PPS) tumour. A secondary goal was to evaluate the correspondence between preoperative and final histopathologic diagnosis after surgery.

Methods: A consecutive series of primary PPS tumours treated between 1985 and 2022 in 2 tertiary referral centres with a microsurgical cervico-parotid approach was considered. The sample included 97 tumours (88 benign and 9 malignant) in 94 patients, of which 11 affected by recurrent tumours when first diagnosed at our centres. The surgical approaches, planned on the presumptive preoperative diagnosis, were pericapsular and en bloc resections (including either conservative or radical resections of the PPS).

Results: Pericapsular and en bloc resections of the PPS achieved complete removal in 88 out of 97 tumours. Relapses after PPS microsurgery occurred only in 8 cases (4 pleomorphic adenomas, 2 malignant schwannomas, one melanoma, and one haemangiopericytoma). Four of the 8 relapsed cases were recurrent cases when first seen at our centres. A complete correspondence between preoperative diagnosis and final histology occurred only in the group of benign lesions classified as paraganglioma, schwannoma, or lipoma, submitted to pericapsular resection.

Conclusions: Microsurgery may support the transcervical-parotid approach, by enhancing the operative space through narrow surgical corridors, improving dissection on critical cleavage planes, vessels and nerves, and allowing the exposure of both caudal and cranial extent of the lesions. In our series, pericapsular and en bloc resections of the PPS were effective in most of the included patients. In high-grade malignancies, where the morbidity of a wider resection beyond the PPS walls may include vessels and nerves, the indication should be accurately balanced.

显微外科治疗咽旁间隙原发肿瘤:一系列连续病例的回顾性观察分析。
目的:探讨显微外科入路治疗咽旁间隙(PPS)肿瘤的安全性和有效性。第二个目的是评估术前和术后最终组织病理学诊断之间的对应关系。方法:对1985年至2022年间在2个三级转诊中心采用显微外科颈腮腺入路治疗的连续系列原发性PPS肿瘤进行分析。样本包括94例患者的97个肿瘤(88个良性和9个恶性),其中11例在我们中心首次诊断时患有复发性肿瘤。手术入路,根据假定的术前诊断,是包膜和整体切除(包括保守或根治性切除PPS)。结果:在97个肿瘤中,有88个肿瘤被完全切除。PPS显微手术后复发8例(多形性腺瘤4例,恶性神经鞘瘤2例,黑色素瘤1例,血管外皮细胞瘤1例)。8例复发病例中有4例在我们中心首次发现时是复发病例。术前诊断与最终组织学完全一致只发生在良性病变组,如副神经节瘤、神经鞘瘤或脂肪瘤,并行包膜切除。结论:显微外科手术可以通过狭窄的手术通道增加手术空间,改善对关键切割面、血管和神经的剥离,并允许显露病变的尾侧和颅侧范围,从而支持经颈腮腺入路。在我们的研究中,包膜和整体切除PPS对大多数患者都是有效的。在高级别恶性肿瘤中,除PPS壁外更广泛切除的病变可能包括血管和神经,应准确平衡适应证。
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