Head and Neck paragangliomas (HNPs) are tumors of the skull base which pose a challenge to surgeons due to the fact that these tumors are vascular, locally aggressive and involve important neurovascular structures like the jugular bulb, internal carotid artery, the facial and the lower cranial nerves. We have identified a set of HNPs that can be considered as complex cases based on certain clinical parameters. The identification of such highrisk complex cases is necessary for logical decision making, proper pre-operative planning and intraoperative management. Of a total of 284 HNPs, 66 were considered as complex cases. We did a retrospective review of these cases and analyzed the outcomes of these cases.