As mentioned in previous articles, postoperative facial palsy is the most common complication of surgery for acoustic neuroma, especially for giant acoustic neuroma (up to 4 cm in diameter), and the mental and psychological impact of facial palsy on the patients is enormous, so we will not repeat it here. Bao Yunhai, Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China (1) Difficulty in preserving the facial nerve anatomy during surgery: Due to the complex relationship between the acoustic neuroma and the facial nerve, the facial nerve may be found in different locations of the tumor, and in some patients, the facial nerve may even pass directly through the tumor. Due to years of compression by the tumor, the facial nerve is often severely deformed, and most of them will be thinned by the compression, and some of them are even as thin as a membrane, which is difficult to be recognized. In surgery, the acoustic neuroma is always exposed before the facial nerve, which is like eating a piece of tofu with a jelly in it, the size and shape of which we don’t know, and the location of which we also don’t know. And we are only allowed to eat the tofu, the jelly must be left as tough. (ii) Our efforts in protecting the facial nerve: Traditional preoperative examinations, including CT and MRI, are unable to show the facial nerve in tumors. However, with the development of medical technology and the emergence of skull base neurography in recent years, we have been able to show most of the facial nerves clearly before surgery (see the attached figure), and we have been able to reproduce them in virtual three-dimensional space through the use of visualization technology, so that we can make a targeted surgical plan according to the relationship between the facial nerves and the tumor before the surgery. We also import the above information into the intraoperative navigation system and combine it with intraoperative neurophysiological monitoring to ensure the safety of the operation to a great extent through various high technologies. You are welcome to visit the Neurosurgery Center of Skull Base at Xuanwu Hospital, Tel: 18601986863.