Auditory neuroma is a common benign tumor in the intracranial pontocerebellar horn region. Early tumors often manifest as hearing loss or even deafness, tinnitus, and balance disorder when they are small. The tumor grows gradually and may cause headache, facial numbness, diplopia and other symptoms. Depending on the size of the tumor, the age of the patient and the functional requirements of the facial auditory nerve, observation, stereotactic radiation therapy and surgery can be chosen according to the specific condition. For small tumors, stereotactic radiation therapy is an effective treatment option, but it may not work for every patient and may sometimes cause worsening of symptoms. Ms. Zhong is 66 years old and discovered an intracranial left-sided auditory neuroma 1 year ago due to hearing loss in her left ear, but the tumor was small in size and she chose to observe it, but during the course of observation MRI revealed an increase in tumor size, so she opted for gamma knife treatment with stereotactic radiation 6 months ago. Unfortunately, Ms. Zhong did not improve her symptoms like most patients treated with Gamma Knife, instead, she continued to lose her hearing and experienced worsening headaches, and a repeat MRI showed a significant increase in tumor volume and hydrocephalus. Under such circumstances, Ms. Zhong could only undergo surgery to remove the tumor, lower the intracranial pressure, relieve the hydrocephalus and alleviate the corresponding symptoms. During surgery, the tumor was found to be very tightly adhered to the surrounding cerebellum and brainstem. Fortunately, our electrophysiological monitoring during surgery was able to detect and confirm the facial nerve in time, and the patient recovered smoothly after surgery, and the facial nerve function was preserved. Gamma Knife is a treatment option for small auditory neuromas. Gamma Knife is able to control the growth of most small auditory neuromas. However, some auditory neuromas undergo necrosis and cystic degeneration after Gamma Knife treatment, and the tumor grows rapidly in size and develops significant compression symptoms. In this case, it is necessary to surgically remove the auditory neuroma, but in this case the tumor envelope is often tightly adherent to the facial nerve and requires electrophysiological confirmation of the facial nerve and careful separation during surgery in order to effectively preserve facial nerve function.