Primary Nerve Sheath Tumors of the Parapharyngeal Space

Abstract

Aims: The aims of this study were to retrospectively analyze the presentation, diagnostic challenges, and optimum treatment of nerve sheath tumors (NSTs) in parapharyngeal space (PPS). Settings and Design: This is a retrospective chart review done at a tertiary care hospital, Pakistan, from January 2009 to April 2020. Methods: All PPS tumors of nerve sheath origin were included in the study. A total of 18 patients satisfied the inclusion criteria. Their clinical presentation, diagnostic modality, surgical approach, and complications were analyzed. Statistical Analysis Used: SPSS version 20 was used for statistical analysis. Results: The male-to-female ratio was 11:7, with a median age at the time of surgery being 43 ± 10.19 years. The most common clinical symptom was neck swelling. Computed tomography scan was the mainstay of investigation (15 cases). Fine-needle aspiration cytology was diagnostic only in three cases. Transcervical approach was used in all the patients except in one patient. The sympathetic chain was involved in five, vagus in two, and hypoglossal and glossopharyngeal in one patient each. However, nerve involvement was uncertain in nine patients. Among postoperative complications, Horner's syndrome was the most common followed by first bite syndrome. Conclusions: PPS NSTs offer a great deal of diagnostic dilemma and an operative challenge. With currently available imaging techniques and meticulous surgery, it is possible to treat PPS NSTs effectively. The nerve of involvement is also important as it can indicate the potential complication that may occur.