Combined endoscopic transcervical-transoral robotic approach for resection of parapharyngeal space tumors

Background: Parapharyngeal space tumors (PPSTs) pose exposure challenges; they are routinely resected by the transcervical approach using blunt/blind finger dissection, increasing the risk of tumor spillage and of neurovascular injury. Large PPSTs or those located high at the skull base often require mandibulotomy or an infratemporal fossa approach, baring considerable morbidity. Methods: The novel minimally invasive approach described, utilizes endoscopic equipment introduced transcervically for circumferential separation of the tumor from the neurovascular structures of the skull base. After the tumor is separated, it is removed en bloc, via transoral robotic surgery (TORS). Results: The technique provides improved visualization and safe vascular control with minimum tumor stress, preventing the need of blunt/blind finger dissections, and allowing complete tumor removal while minimizing tumor spillage, nerve injury, and blood loss, maintaining excellent cosmetic and functional results. Conclusion: This approach could be utilized for the removal of large benign PPSTs, or small PPSTs located high at the skull base.