Neurilemomas of the parapharyngeal space

Objective: To review the surgical management of neurilemomas of the parapharyngeal space (PPS). Design: Retrospective survey of the clinical presentation, radiological features, surgical approaches, surgical findings, and postoperative neurological sequelae of neurilemomas of the PPS. Setting: Academic tertiary care head and neck referral center. Patients: 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 surgical approach, and neurological sequelae of surgery. Results: Radiological studies could distinguish prestyloid from poststyloid tumors and, with poststyloid tumors, can usually differentiate between glomus tumor and neurilemoma. The transcervical approach permitted adequate surgical access. Five of the tumors in the poststyloid space were neurilomomas originating from the sympathetic nervous system, and all 5 patients with these tumors developed Horner syndrome postoperatively. Conclusions: 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 neurilemomas can be resected through a transcervical approach. Resection of neurilemomas has an attendant risk for neurological dysfunction.