32 Clinical and Experimental Otorhinolaryngology Vol. 2, No. 1: 28-32, March 2009 proach alone. 6 out of 7 Type C tumors were resected completely and are under observation without any sign of recurrence. All Type D tumors resulted in partial resection and 1 out of 7 Type C tumors was partially resected. GKS after partial resection of the tumor was reported to be effective (10), but recurrence was observed in 1 out of 3 cases in our data. We recommend that com- bined approach in cooperation with the neurosurgery department should be implemented in the first place in cases of jugular fora- men ganglioma with intracranial extension, rather than planning a staged operation. Jackson et al. showed that a single-stage resec- tion and reconstruction offered the greatest likelihood of com- plete tumor removal while preserving local tissue for use in recon- struction (12). Combined approach can include infratemporal fossa, suboccipital, middle fossa, anterior craniofacial, translabryn- thine approach, and more. These approaches can be combined depending on the location of the tumor (12, 13). Combined ap- proach can expose the tumor better than single approach since better operative view of the tumor can be obtained from two di- fferent angles, which should result in better chance of complete removal of the tumor (13). The widened view also prevents exces- sive effort to remove unvisualized portion of the tumor, which might cause injuries to the nerves. There is a problem to seal a larger defect in combined approach compared with a single ap- proach, but advances in reconstruction technique of the defect has decreased concerns to this problem (12, 13). Combined ap- proach is also much better to maintain compliance of the patient for the treatment. In our cases, all patients in whom staged oper- ation was planned refused to undergo the secondary operation due to decreased compliance after the first operation. In our cases, infratemporal approach was sufficient in complete resection of the tumor in most cases when intracranial extension was not present, with the aid of embolization. No mortality was encountered and permanent postoperative complications occurred in few cases, as observed in the results. With skilled surgical tech- nique, infratemporal fossa approach can be considered as a safe and effective approach for removal of jugular foramen paragan- glioma without intracranial extension. CONCLUSION Glomus jugulare tumors can be presented in various manners. In our result, low cranial involvement was present in most of the cases, suggesting that neurologic examination of the low cranial nerve is crucial. 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