咽旁间隙肿瘤诊治进展

Advances in the Diagnosis and Treatment of Parapharyngeal Space Tumors

摘要:

咽旁间隙(PPS)肿瘤是一类少见的头颈深部肿瘤,总体以良性病变为主,但病理来源复杂,邻近颈内动脉、颈内静脉及后组脑神经,术前定性、入路选择和功能保护均具有较高难度。近年来,增强CT、MRI、血管成像、影像引导取材、内镜辅助经口手术及经口机器人手术等技术不断发展,推动PPS肿瘤诊疗由经验性处理转向解剖分区基础上的分层决策。主要综述PPS肿瘤的解剖分区、病理类型、临床表现、影像评估、治疗策略、并发症及随访管理,强调依据茎突前区与茎突后区判断组织来源,结合血管神经关系选择开放或经口微创路径,并在肿瘤控制与神经功能保护之间进行个体化权衡。

Abstract:

Parapharyngeal space (PPS) tumors are uncommon deep head and neck neoplasms, most of which are benign. Because of their deep location, heterogeneous histological origins, and close relationship with the internal carotid artery, internal jugular vein, and lower cranial nerves, accurate preoperative assessment and function-preserving management remain challenging. Advances in contrast-enhanced CT, MRI, vascular imaging, image-guided tissue sampling, endoscope-assisted transoral surgery, and transoral robotic surgery have promoted a shift from experience-based treatment to anatomy-oriented, risk-stratified decision-making. This review summarizes the anatomical classification, pathological spectrum, clinical manifestations, imaging evaluation, therapeutic strategies, complications, and follow-up of PPS tumors. Particular emphasis is placed on determining tumor origin according to the prestyloid and poststyloid compartments, selecting open or transoral minimally invasive approaches according to neurovascular relationships, and balancing oncological control with preservation of cranial nerve function.