AbstractObjectives/Hypothesis:Treatment for jugulotympanic paragangliomas (JTPs) is shifting from radical toward function‐preserving surgery. Alternative primary treatments are available, such as stereotactic radiotherapy (SRT) and radiosurgery. The aim of this study was to analyze the results after primary function‐preserving surgery with or without adjuvant radiotherapy, or primary SRT, in the treatment of JTPs.Study Design:Retrospective analysis.Methods:From 2000 to 2010, 45 patients (mean age, 62.5 years) received function‐preserving treatment for JTPs—four type A paragangliomas (8.9%), 19 type B (42.2%), 13 type C (28.9%), and nine type D (20%) in the Fisch classification. The patients were retrospectively assigned to three groups: primary function‐preserving surgery, primary stereotactic radiotherapy, and close follow‐up. The end points for analysis were long‐term tumor control, cranial nerve function, and hearing.Results:A total of 64.4% of the patients (n = 29) received primary surgery, with complete resection in 18. Eleven patients had surgical tumor reduction, with fractionated postoperative radiotherapy (mean 53.5 Gy; range, 50–56 Gy) in five cases and radiosurgery (18 Gy) in one case; five patients received close follow‐up. Twelve patients (26.7%) underwent primary radiotherapy (11 with SRT [mean, 50 Gy]; one with radiosurgery [16 Gy]). Four patients (8.9%) received a wait‐and‐scan strategy. The mean follow‐up was 46.8 months. The overall tumor control rate was 97.2%.Conclusions:With these high tumor control rates, consistent with the literature, function‐preserving therapy for JTPs currently appears to offer the greatest benefit for patients.