NEURILEMOMAS OF THE PARAPHARYNGEAL SPACE

Objective: To review the surgical management of neurilemomas of the pa rapharyngeal space (PPS). Design: Retrospective sun ey of the clinical presentation, radiological features, surgical aproaches, surgical fin dings, and postoperative neurological sequelae of neurilemomas of the PPS. Setting: Academic tertiary care head and neck referral center. Pa tients: Fourteen patients with neurilemomas of the PPS, 12 were in the poststyloid compartment. Interventions: Preoperative evaluation with computed tomography and/or magnetic resonance imaging with or without angiography. Surgical resection was performed through a transcervical approach. Main Outcome Measures: Radiological features, adequacy of su rgical approach, and neurological sequelae of surgery. Results: radiol ogical studies could distinguish prestyloid from poststyloid tumors an d, with poststyloid tumors, can usually differentiate between glomus t umor and neurilemoma. The transcervical approach permitted adequate su rgical access. Five of the tumors in the poststyloid space were neuril omomas originating from the sympathetic nervous system, and all 5 pati ents with these tumors developed Horner syndrome postoperatively. Conc lusions: Computed tomographic and/or magnetic resonance studies should be routinely obtained to evaluate tumors of the PPS, but angiography is indicated only in selected cases, Both prestyloid and poststyloid n eurilemomas can be resected through a transcervical approach. Resectio n of neurilemomas has an attendant risk for neurological dysfunction.