Giant parapharyngeal space lipoma: case report and surgical approach.

Large parapharyngeal space tumors near critical neurovascular structures pose challenging management problems. Only eight cases of a lipoma in the parapharyngeal space have been reported. We present a surgical approach that permits safe resection of such unusual tumors.A 49-year-old man had a 2-year history of progressive pain in the left neck radiating from the shoulder to the occiput. Contrast-enhanced computed tomography (CT) of the neck demonstrated a fat-attenuation mass located in the poststyloid parapharyngeal space. The mass extended into the foramen transversarium at the level of the second cervical vertebra and encased the vertebral artery. The tumor was removed through an extended transcervical approach that included transection of the attachments of the sternocleidomastoid, trapezius, splenius capitus, and the longissimus capitus muscles. The approach provided access to the first cervical vertebra, allowing dissection of the tumor from the vertebral artery in the foramen transversarium. An extended transcervical approach provides exposure from the carotid artery to the vertebral artery and facilitates the complete excision of large parapharyngeal space masses.