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[The surgical management of parapharyngeal space neoplasms with skull base involved].

OBJECTIVE
To describe the most appropriate treatment to parapharyngeal space tumors with skull base involved.


METHOD
From March 2000 to July 2004, a retrospective review of 36 patients with tumors of parapharyngeal space with skull base involved and treated surgically procedure was performed. Analyze the clinical characteristics of different tumors of parapharyngeal space with skull base involved. To the various tumors in this series, several surgical approaches were selected: the transcervical (n=15) and transcervical-transparotid approaches (n=10) were the most commonly performed surgical procedures followed by the transmaxillary swing approach (n=5), the transmandible swing approach (n= 4), and transorbitozygomatic-middle fossa approach (n=2).


RESULT
In the 36 cases, 5 cases were malignant carcinoma and the others (n=31) were benign. All benign tumors in 31 cases had complete resection with no recurrence. Of the 5 patients with malignant tumors, 2 had SCC (squamous cell carcinoma) of nasopharynx infra-mucous membrane with metastasis in the parapharyngeal space and skull base lesions, after the pathologic identification by the surgical management of transcervical approach, both had undergone post-operative radiotherapy, 1 had disease free with a 3-year follow-up; the other after a follow-up of 5 years, was still alive with disease. Of the other 3 patients, 1 patient with the skull base lesions of malignant neurofibroma had recurrence after a 3-year follow-up, died without therapy at the end; 1 with malignant schwannomas and skull base lesions was alive with no evidence of disease after a follow-up of 2 years; 1 patient with mucoepidermoid carcinoma in deep lobe of parotid gland had operation done 3 months ago, was still under followed. In the 36 cases, post-operative hoarseness occurred in 3 cases; Horner's syndrome occurred in 4 cases; 2 patients had glossal deviation, and it had recovered 3 months later.


CONCLUSION
Different tumors of parapharyngeal space with skull base involved have different clinical characteristics. Therefore, we should depend on its characteristics to choose the most appropriate treatment.