Postoperative facial palsy is the most common complication of surgery for acoustic neuroma, especially for giant acoustic neuroma (up to 4cm in diameter). Facial paralysis not only affects the patient’s aesthetic appearance, but also the psychological changes that follow the strange facial expression: the patient is unwilling to go out, unwilling to meet people, self-isolation, and cut himself off from the society. In addition, as the eyelids of severe facial paralysis cannot be closed, coupled with the abnormal secretion of tears, it often leads to exposure keratitis, loss of vision in the affected eye, or even blindness, so it is very important to correctly treat facial paralysis after acoustic neuroma surgery. There are two kinds of postoperative facial paralysis of acoustic neuroma: (1) Facial paralysis with preservation of intraoperative facial nerve anatomy: i.e., facial paralysis that occurs due to mechanical stimulation of the facial nerve during the operation with the structure of the facial nerve remaining intact and continuity not interrupted. At present, for giant acoustic neuroma, the highest rate of preserved facial nerve anatomy in the world is 92% by Prof. Samii, a master neurosurgeon from Germany, and about 80% in China; for this group of patients, the recovery of facial paralysis should be promoted by active facial muscle exercise (insisting on lifting forehead lines, frowning, closing eyes, baring teeth, puffing cheeks, etc., in the morning, midday, and evening), passive massage, kneading, physiotherapy, and acupuncture. In most patients, facial paralysis recovers to varying degrees within six months after surgery. However, if the facial paralysis has not recovered after six months, the patient should be considered for facial nerve anastomosis (facial-hypoglossal nerve anastomosis or facial-parasympathetic nerve anastomosis) because the effect of nerve anastomosis is inversely proportional to the duration of the facial paralysis and the earlier the anastomosis is performed, the better the result is; on the contrary, the later the anastomosis is performed, the worse the result is. (ii) No anatomical preservation of the facial nerve during the operation: If the facial nerve is severed during the operation, or even if the facial nerve is removed together with the tumor, then the possibility of facial paralysis recovering on its own is very slim, and nerve anastomosis should be performed as soon as possible without hesitation. At present, in the Department of Neurosurgery of Xuanwu Hospital, if the facial nerve is dissected during the resection of giant acoustic neuroma, direct anastomosis of the severed end of the nerve is preferred, and if the nerve defect is large, then facial-sublingual nerve anastomosis will be performed immediately, and the results are encouraging: the patient’s facial static tension was normal 6 months after the anastomosis and the facial paralysis could not be seen in a quiet state, and the eyelid could be closed, and the baring of the teeth and the puffing of the cheeks were also greatly improved. (In view of the protection of patient’s privacy, the facial photos before and after the nerve anastomosis could not be uploaded for publication.) Therefore, for facial paralysis after acoustic neuroma surgery, it is important to ask your surgeon whether the facial nerve was preserved during surgery. so that the next step in treatment can be decided.