Response to comment on: the combined transmastoid retro- and infralabyrinthine transjugular transcondylar transtubercular high cervical approach for resection of glomus jugulare tumors

We appreciate the comments by Dr. Sanna regarding our article (1). We recognize Dr. Sanna has much experience with these tumors and that, as cranial base surgeons, we should work as a team of neurosurgeons, otologists, and occasionally, head and neck surgeons and plastic surgeons. We also agree that one of the most important issues is the exposure and control of the internal carotid artery. We tailor the approach in terms of the retrojugular, transjugular, or infrajugular exposure with regard to the size and extension of the tumor. If the jugular foramen tumor is mainly intradural, we perform the combined transtemporal, transmastoid, and retrosigmoid intradural procedure for the resection of theintradural portion. If the jugular bulb is already occluded and the tumor has both intradural and jugular foramen components, we perform a combined intradural and extradural exposure. If the tumor is extensive, such as a glomus jugulare tumor involving the infrajugular component, infratemporal carotid artery, and jugular bulb, we do a combined transmastoid infralabyrinthine and combined transtemporal transjugular and infrajugular transcondylar and high cervical exposure. For extensive glomus jugular tumors, we always expose the highcervical internal carotid artery for proximal control. We also expose the C7 infratemporal carotid artery in front of the jugular bulb by drilling the inferior bony tympanic ring and translocating the facial nerve anteriorly.