Objective To compare the efficacy of transcervical(TC) approach, endoscopy-assisted TC approach and endoscopy-assisted transoral(TO) approach for resection of benign tumors in the parapharyngeal space. Methods A retrospective review of 159 cases with primary benign tumors in the parapharyngeal space treated at ENT & HN Surgery Dept, Xiangya Hospital, Central South University from January 2013 to May 2023 was performed. All patients underwent one of the three surgeries: endoscopy-assisted TC approach, endoscopy-assisted TO, and TC approach. Using one-way ANOVA and Chi-square test to compare surgical outcomes and prognosis. Result There was no significant difference in bleeding volume (F=2.64，P=0.074) , postoperative drainage tube retention time (F=2.44，P=0.091) , drainage volume (F=2.88，P=0.060) , and discharge time (F=0.77，P=0.464) among the three groups. Endoscopy-assisted TO approach could shorten surgical time (F=10.70，P＜0.001) compared to endoscopy-assisted TC and TC approaches, and the incidence of postoperative complications was lower (χ2=9.426，P=0.009). Conclusion The three surgical approaches used in this study are safe and feasible, capable of completely removing tumors while ensuring a lower incidence of complications. Endoscopy-assisted TO approach has smaller trauma, shorter surgical time and lower incidence of postoperative complications compared to endoscopy-assisted TC and TC groups. However, endoscopic operation is challenging and have strict indications. Therefore, it is necessary to flexibly select the surgical approach based on symptoms, signs, the nature of the tumor, and imaging characteristics, to maximize the benefit for the patient.