Patient-specific three-dimensional planning for surgical approach selection in parapharyngeal space lesions: development of the Vall d’Hebron 3D-PPS Algorithm

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.