Endoscopic endonasal resection of a parapharyngeal cavernous hemangioma: technical case report and literature review

Abstract Background and Importance: Cavernous hemangiomas are benign vascular tumors derived from endothelial cells most commonly found in the oropharynx and larynx. Few cases have been reported in the parapharyngeal space (PPS). We report a rare case of cavernous hemangioma originating in the PPS resected endoscopically via an endonasal transsphenoidal approach. Clinical Presentation The clinical presentation, disease course, and management of a patient with cavernous hemangioma of the PPS are presented. Additionally, MEDLINE database query for all case series or reports of cavernous hemangioma involving the PPS, and pertinent clinical data were extracted. In this recent case, the patient presented with globus sensation over a period of two months. MRI and CT demonstrated a space-occupying lesion of the right PPS. The patient underwent endoscopic endonasal transpterygoid/transmaxillary surgical resection without complications. Final pathology demonstrated cavernous hemangioma. This case represents one of nine reported cases of PPS cavernous hemangiomas. Total resection was achieved in 89 percent of cases with no complications or recurrence. Surgical approaches to the PPS included transcervical, transoral, endonasal transpterygoid/transmaxillary, and other external approaches. Conclusion Cavernous hemangioma of the PPS is a rare entity without definitive guidelines for surgical approach. Endoscopic endonasal resection is a viable approach to the PPS.