Transcervical vs. Transcervical-Combined Surgical Approaches for Primary Parapharyngeal Space Tumors: A Systematic Review of Surgical and Functional Outcomes.

Primary parapharyngeal space (PPS) tumors are rare neoplasms comprising 0.5% of head and neck tumors. Their complex anatomical location and proximity to critical neurovascular structures pose significant surgical challenges. While transcervical and transcervical-combined approaches represent the primary surgical techniques, no comprehensive systematic comparison exists. This systematic review compared surgical success, complications, functional outcomes, and recurrence rates between these approaches. Following PROSPERO registration (CRD420251037201), we searched PubMed, Cochrane, Web of Science, Google Scholar, and ScienceDirect without date restrictions. Independent dual screening identified retrospective cohort studies and case series comparing both approaches. Data extraction and risk of bias assessment employed standardized tools, with synthesis conducted per PRISMA 2020 guidelines using narrative analysis. Ten studies encompassing 505 patients with 508 tumors met inclusion criteria. Both approaches achieved excellent complete resection rates (95-100%). Transcervical approaches demonstrated lower overall complication rates (4.8-52.6%) versus transcervical-combined approaches (7.7-100%), though rates varied substantially by tumor type, and differences likely reflect case selection rather than approach-specific effects. Cranial nerve injuries (VII, X, XII) constituted predominant complications. Infratemporal fossa approaches showed the highest morbidity. Recurrence rates ranged from 0-30.3% without consistent patterns favoring either approach. Transcervical-combined approaches were essential for superior compartment extension and for skull base involvement. Both transcervical and transcervical-combined approaches achieve excellent tumor resection with acceptable morbidity when appropriately selected. For most benign PPS tumors, a transcervical approach may be preferred. Combined approaches may be considered in specific anatomic scenarios that require enhanced exposure, particularly when the superior compartment and skull base are involved, although the decision is always highly individual.