Objective To investigate the diagnosis of parapharyngeal space schwannoma and the selection of surgical approach modes. Methods 14 medical records of patients with parapharyngeal space schwannoma were retrospectively analyzed. According to preoperative CT and MRI, surgical approach was determined depending on the distance between the tumor and tonsillar capsule and the tumor main location: with a distance between the tumor and tonsillar capsule ≤1cm, and the main tumor breaking into the mouth, 4 cases via the mouth diameter road; with the distance >1cm, and the tumor projected to the outside of the main body, 10 cases via the neck diameter road. There was no significant relationship between surgical approach and the tumor size. Results All patients had received successful surgery, and were followed up for 6 months to 6 years without recurrence. Conclusions Neck CT, MRI, and DSA are good means of the diagnosis of parapharyngeal space schwannoma, and the selection of surgical approach depends on the distance between the tumor and tonsillar capsule and tumor main location. No matter through which pathway, there are no serious complications.