Post-styloid parapharyngeal neurogenic tumors: imaging-based prediction of nerve origin and clinical outcomes — a single-center retrospective case series

By
Pei-Han Liu
Hsiu-San Hsu
Chun-Hung Hua
Li-An Su
Wan-Ling Yi
Yung-An Tsou
Chia-Der Lin
Liang-Chun Shih
Chien-Chi Lu
June 23, 2026
0 min

Frontiers In Surgery

Overview

This study evaluates imaging techniques for predicting the nerve of origin in neurogenic tumors located in the post-styloid parapharyngeal space (PPS). The findings indicate that imaging accurately predicted the nerve of origin in 88.9% of cases, highlighting the importance of preoperative assessment in surgical planning.

Background

Neurogenic tumors in the post-styloid parapharyngeal space are rare, comprising a small percentage of head and neck tumors. Accurate identification of the nerve of origin is crucial for minimizing surgical risks and complications, such as vocal fold paralysis and Horner's syndrome. This study aims to enhance preoperative evaluation methods through imaging techniques.

Data Highlights

Parameter	Value
Number of patients	15
Average age	44.5 years
Male patients	67%
Accurate nerve prediction	88.9%
Postoperative complications	Vocal fold paralysis, Horner's syndrome

Key Findings

15 patients were diagnosed with post-styloid PPS tumors, with an average age of 44.5 years.
Imaging indicated a vagal source in 11 tumors and a sympathetic chain source in 4 tumors.
Intraoperative verification confirmed the imaging predictions in 8 out of 9 surgical cases (88.9% accuracy).
One patient experienced postoperative Horner's syndrome due to misidentified nerve origin.
No recurrence or disease progression was noted during follow-up.

Clinical Implications

The study suggests that imaging-derived predictions of nerve origin can significantly aid in surgical planning for neurogenic tumors in the PPS. Accurate preoperative assessments may help reduce the risk of postoperative complications.

Conclusion

Imaging techniques that evaluate vessel displacement patterns can provide valuable insights into the nerve of origin for neurogenic tumors in the post-styloid parapharyngeal space, supporting better surgical outcomes.