# Transcervical vs. Transcervical-Combined Surgical Approaches for Primary Parapharyngeal Space Tumors: A Systematic Review of Surgical and Functional Outcomes

## TL;DR

This study compares two surgical methods for removing rare neck tumors, finding that a simpler neck-only approach is generally safer and effective, while combined methods are needed for more complex cases.

## Contribution

The paper provides the first systematic review comparing surgical outcomes of transcervical and transcervical-combined approaches for parapharyngeal space tumors.

## Key findings

- Both surgical approaches achieved high complete tumor resection rates (95–100%).
- Transcervical approaches had lower complication rates compared to combined approaches, though rates varied by tumor type.
- Combined approaches were necessary for tumors extending to difficult-to-reach areas like the skull base.

## Abstract

Tumors that grow in the parapharyngeal space, a small area deep in the neck near important blood vessels and nerves, are very rare but challenging to remove surgically. Surgeons can access these tumors through different routes, with the most common being a neck incision alone or a neck incision combined with additional cuts through other structures for better access. This study reviewed all available research comparing these two surgical approaches to determine which is safer and more effective. We analyzed 10 studies involving 505 patients to compare success rates, complications, and tumor recurrence between the approaches. Both methods successfully removed tumors in almost all cases. The simpler neck-only approach caused fewer complications overall, though complication rates varied depending on tumor characteristics. The main complications for both approaches involved injury to nerves controlling facial movement and swallowing. Transcervical-combined approaches were necessary when tumors extended to certain difficult-to-reach areas. Our findings help surgeons choose the best approach, with the decision being highly individual for each patient, generally recommending the simpler neck-only method for most benign tumors while reserving combined approaches for specific cases requiring greater surgical access.

Primary parapharyngeal space (PPS) tumors are rare neoplasms comprising 0.5% of head and neck tumors. Their complex anatomical location and proximity to critical neurovascular structures pose significant surgical challenges. While transcervical and transcervical-combined approaches represent the primary surgical techniques, no comprehensive systematic comparison exists. This systematic review compared surgical success, complications, functional outcomes, and recurrence rates between these approaches. Following PROSPERO registration (CRD420251037201), we searched PubMed, Cochrane, Web of Science, Google Scholar, and ScienceDirect without date restrictions. Independent dual screening identified retrospective cohort studies and case series comparing both approaches. Data extraction and risk of bias assessment employed standardized tools, with synthesis conducted per PRISMA 2020 guidelines using narrative analysis. Ten studies encompassing 505 patients with 508 tumors met inclusion criteria. Both approaches achieved excellent complete resection rates (95–100%). Transcervical approaches demonstrated lower overall complication rates (4.8–52.6%) versus transcervical-combined approaches (7.7–100%), though rates varied substantially by tumor type, and differences likely reflect case selection rather than approach-specific effects. Cranial nerve injuries (VII, X, XII) constituted predominant complications. Infratemporal fossa approaches showed the highest morbidity. Recurrence rates ranged from 0–30.3% without consistent patterns favoring either approach. Transcervical-combined approaches were essential for superior compartment extension and for skull base involvement. Both transcervical and transcervical-combined approaches achieve excellent tumor resection with acceptable morbidity when appropriately selected. For most benign PPS tumors, a transcervical approach may be preferred. Combined approaches may be considered in specific anatomic scenarios that require enhanced exposure, particularly when the superior compartment and skull base are involved, although the decision is always highly individual.