ArticleFrontiers in oncology2026
Patient-specific three-dimensional planning for surgical approach selection in parapharyngeal space lesions: development of the Vall d'Hebron 3D-PPS Algorithm.
Article in Frontiers in oncology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Introduction: Surgical management of parapharyngeal space (PPS) lesions remains challenging because of their deep anatomical location and close relationship to major neurovascular structures. Although patient-specific three-dimensional (3D) reconstruction improves anatomical visualisation, standardised methods for incorporating this information into surgical approach selection remain poorly defined. We developed the Vall d'Hebron 3D-PPS Workflow and Algorithm to integrate patient-specific anatomy into preoperative decision-making. Methods: Prospective observational study including 17 consecutive patients with PPS lesions treated at a tertiary referral centre. All patients underwent patient-specific 3D virtual planning integrating CT and MRI datasets. The primary outcome was the impact of the Vall d'Hebron 3D-PPS Workflow on surgical approach selection. Secondary outcomes included postoperative complications, surgical margins or completeness of lesion resection, length of hospital stay and surgeon-reported usefulness of the 3D models. Results: Surgical treatment consisted of transoral robotic surgery (TORS) in seven patients (41.2%), transcervical surgery in four (23.5%), combined external plus TORS in four (23.5%) and transcervical-transparotid surgery in two (11.8%). Patient-specific 3D planning modified the initially planned surgical approach in four patients (23.5%). Surgeons rated the models as very useful (Likert 5) in 76.5% of cases and useful (Likert 4) in the remaining 23.5%. Complete lesion resection or negative surgical margins were achieved in 82.4% of patients. Postoperative complications occurred in two patients (11.7%), and no mortality was observed. Conclusion: The Vall d'Hebron 3D-PPS Workflow complements conventional imaging by integrating patient-specific anatomy into a structured preoperative decision-making process for surgical approach selection in PPS lesions.
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