Neurological complications in benign parapharyngeal space tumors --
Systematic review and meta-analysis
Abstract
Background: Parapharyngeal space tumors with complex anatomy and diverse
histology and have remained a challenging phenomenon for treating
physicians. Objective: Assess the factors for selection of surgical
approach and association of neurological complications with tissue of
origin in parapharyngeal space tumors. Type of review: Systematic review
and meta-analysis of retrospective studies in accordance with PRISMA
guidelines Methods: We have conducted a comprehensive web search on
Pubmed, Web of Science, EMBASE, Cochrane Library, Biomedical Literature
Database (CBM) and Clinicaltrials.gov. Two researches reviewed all
identified articles independently with a third reviewer for
adjudication. Patient demographics and other clinicopathological
characteristics were explored. Main outcome measures: Primary outcomes
assessed were post-operative complications i.e. neurological and
salivary, surgical approaches used and the factors used for the
selection of surgical approaches. Results: The systematic review has
identified 631 patients of benign parapharyngeal space tumors with
neurogenic and salivary tissue histology in 13 studies with a mean age
of 42.9 ± 7.76 years and a median follow-up of 40.98 ± 19.1 months.
Salivary gland (50.8%) and neurogenic (49.1%) tumors were the most
common histological entities. Tumor size, location, histology, deep
parotid lobe involvement and proximity to great vessels or skull base
were the deciding factors in selecting the surgical approach. Factors
considered to select surgical approach do not seem to have a correlation
with the outcome in terms of neurological sequalae (p=0.106).
Neurological deficit was observed in 48% of patients with neurogenic
histology (148/310) while only 13% patients with salivary tumor
developed neurological deficit. The pooled RR was 2.41 (95% CI 1.80 –
3.23, p=0.001). Conclusion: Neurologic complications are significantly
associated with neurogenic benign tumors rather than surgical approach.