The complete resection of advanced glomus tumors involving the skull base has become feasible in the modern age of microsurgery. Despite the advance of microsurgical technique, resection of glomus tumors with extensive skull base involvement is not without risk of major complication. Even with these risks, surgical resection remains the standard and most successful therapeutic modality for these tumors. This review examines standard microsurgical approaches and techniques for the treatment of paragangliomas involving the temporal bone and lateral skull base. Results: Outcomes are separated between glomus tympanicum cases and skull base glomus tumor cases. In the glomus tympanicum group, complete surgical control approaches 93%. In the skull base group, complete surgical control approaches 85% of cases with a 5% recurrent rate. Cerebrospinal fluid (CSF) leakage has been reduced to less than 5% of cases with intracranial extension. New lower cranial nerve deficits range from 39% to 21%. Despite new cranial nerve deficits, satisfactory functional recovery is achieved in an overwhelming majority of cases. Mortality rate has been reduced to less than 3%. Conclusions: Surgical resection of glomus tumors remains an effective technique with good functional outcomes and long-term control. Results have been improving as skull base surgery techniques advance. To date, alternative therapies have not proven more effective. © 2003, Elsevier B.V.