{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,21]],"date-time":"2026-09-21T05:03:31Z","timestamp":1789967011989,"version":"4.0.1"},"reference-count":20,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,9,21]],"date-time":"2026-09-21T00:00:00Z","timestamp":1789948800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Oncol."],"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>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\u2019Hebron 3D-PPS Workflow and Algorithm to integrate patient-specific anatomy into preoperative decision-making.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>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\u2019Hebron 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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>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\u2013transparotid 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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>The Vall d\u2019Hebron 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.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fonc.2026.1954820","type":"journal-article","created":{"date-parts":[[2026,9,21]],"date-time":"2026-09-21T04:29:09Z","timestamp":1789964949000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Patient-specific three-dimensional planning for surgical approach selection in parapharyngeal space lesions: development of the Vall d\u2019Hebron 3D-PPS Algorithm"],"prefix":"10.3389","volume":"16","author":[{"given":"Pablo","family":"Verg\u00e9s Fort","sequence":"first","affiliation":[{"name":"Otolaryngology Head and Neck Department, Vall d\u2019Hebron Barcelona Hospital Campus","place":["Barcelona, Spain"]},{"name":"Universitat Aut\u00f2noma de Barcelona, UD Vall Hebron","place":["Barcelona, Spain"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Juan Fernando","family":"Fuentes Cabrera","sequence":"additional","affiliation":[{"name":"Otolaryngology Head and Neck Department, Vall d\u2019Hebron Barcelona Hospital Campus","place":["Barcelona, Spain"]},{"name":"Universitat Aut\u00f2noma de Barcelona, UD Vall Hebron","place":["Barcelona, Spain"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"S\u00edlvia","family":"Naches Solsona","sequence":"additional","affiliation":[{"name":"Otolaryngology Head and Neck Department, Vall d\u2019Hebron Barcelona Hospital Campus","place":["Barcelona, Spain"]},{"name":"Universitat Aut\u00f2noma de Barcelona, UD Vall Hebron","place":["Barcelona, Spain"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laura","family":"Grau deDiego","sequence":"additional","affiliation":[{"name":"Otolaryngology Head and Neck Department, Vall d\u2019Hebron Barcelona Hospital Campus","place":["Barcelona, Spain"]},{"name":"Universitat Aut\u00f2noma de Barcelona, UD Vall Hebron","place":["Barcelona, Spain"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laura","family":"Escot Garcia","sequence":"additional","affiliation":[{"name":"Otolaryngology Head and Neck Department, Vall d\u2019Hebron Barcelona Hospital Campus","place":["Barcelona, Spain"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Juan Carlos","family":"Tortajada Bustelo","sequence":"additional","affiliation":[{"name":"Otolaryngology Head and Neck Department, Vall d\u2019Hebron Barcelona Hospital Campus","place":["Barcelona, Spain"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jose Miguel","family":"Rodr\u00edguez S\u00e1nchez","sequence":"additional","affiliation":[{"name":"Otolaryngology Head and Neck Department, Vall d\u2019Hebron Barcelona Hospital Campus","place":["Barcelona, Spain"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David","family":"Vir\u00f3s Porcuna","sequence":"additional","affiliation":[{"name":"Otolaryngology Head and Neck Department, Vall d\u2019Hebron Barcelona Hospital Campus","place":["Barcelona, Spain"]},{"name":"Universitat Aut\u00f2noma de Barcelona, UD Vall Hebron","place":["Barcelona, Spain"]},{"name":"Vall d\u2019Hebron Research Institute (VHIR)","place":["Barcelona, Spain"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,9,21]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","DOI":"10.1002\/hed.25425","article-title":"Contemporary management of primary parapharyngeal 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