ABSTRACT
Large parapharyngeal space tumors near critical neurovascular structures pose challenging
management problems. Only eight cases of a lipoma in the parapharyngeal space have
been reported. We present a surgical approach that permits safe resection of such
unusual tumors.
A 49-year-old man had a 2-year history of progressive pain in the left neck radiating
from the shoulder to the occiput. Contrast-enhanced computed tomography (CT) of the
neck demonstrated a fat-attenuation mass located in the poststyloid parapharyngeal
space. The mass extended into the foramen transversarium at the level of the second
cervical vertebra and encased the vertebral artery. The tumor was removed through
an extended transcervical approach that included transection of the attachments of
the sternocleidomastoid, trapezius, splenius capitus, and the longissimus capitus
muscles. The approach provided access to the first cervical vertebra, allowing dissection
of the tumor from the vertebral artery in the foramen transversarium. An extended
transcervical approach provides exposure from the carotid artery to the vertebral
artery and facilitates the complete excision of large parapharyngeal space masses.
KEYWORDS
Parapharyngeal space - lipoma - skull base surgery - vertebral artery
