Microdebrider cavitation and transcervical removal of parapharyngeal schwannomas approaching the skull base

Abstract

Removal of parapharyngeal space (PPS) schwannomas approaching the skull base through a purely transcervical approach requires adequate visualization of the surgical field to obtain complete resection with minimal sequelae. This is a retrospective series of four patients undergoing transcervical removal of sympathetic chain PPS schwannomas abutting the skull base by an intracapsular microdebrider tumor cavitation. Radiologic data, complications, functional outcomes, and follow-up status were considered. MRI was suggestive of PPS schwannoma in all cases, and correctly predicted the nerve of origin in three out of four cases. All patients developed postoperative Claude Bernard-Horner and first-bite syndromes. One patient also presented temporary neuropraxia of the IX cranial nerve, and another of the IX and X cranial nerves. Microdebrider cavitation of sympathetic chain PPS schwannoma abutting the skull base proved to be a reliable technique allowing good visualization of adjacent neural and vascular structures through a purely transcervical approach, while maintaining a low complication rate.