Objective: To investigate the microsurgical management of large auditory neuroma by suboccipital minimally invasive incision, and to explore whether this treatment method can save time and improve the efficiency of treatment in terms of access method while the tumor is completely resected, the function of facial nerve is preserved, and the hearing is preserved in the same condition. Methods: A retrospective analysis of 67 cases of auditory neuroma with a diameter greater than 3 cm treated by microsurgery via the posterior suboccipital sigmoid sinus approach in the past 5 years, accounting for 50.8% of 132 cases of auditory neuroma in the same period, in which a conventional straight suboccipital incision (about 12 cm long) and a minimally invasive incision (about 5 cm long) were used respectively. The tumor was resected in the sequence of releasing cerebral fluid – grinding open the internal auditory tract – intracapsular resection of tumor – inferior border of tumor – medial border – superior border – brain stem surface. Results: the suboccipital direct incision was about 12 cm long, the average time spent for the approach was 50 minutes, the size of the bone window was 3 cm×3.5 cm, the average time for the cranial closure was 1 hour, the average length of surgery was 6 hours, the average number of hospital days was 14 days, the average bleeding volume was 300 ml; the suboccipital minimally invasive incision was about 5 cm long, the average time spent for the approach was 20 minutes, the size of the bone window was 1.5 cm×1.5 cm, the average time for the cranial closure was 20 minutes, the average length of surgery was 4 hours. The average tumor total resection rate was 97% in the whole group; 2 cases were subtotal resection, 1 case was not total resection because the tumor was embedded in the midbrain by direct incision and a small part of it remained, and 1 case was minimally invasive incision with tumor diameter more than 6cm and a small part of it remained in the ventral part of the medulla oblongata with serious adhesions. The facial nerve was anatomically preserved in 67 cases, and the facial nerve function was preserved in 10 cases of grade I and 55 cases of grade II-III or above (H-B classification), and hearing was preserved in 4 cases of 8 cases who had hearing before surgery. Conclusion: On the basis of proficiency in microscopic grinding and drilling techniques and microsurgery techniques. Minimally invasive incision and longitudinal straight incision can achieve the same treatment effect as straight incision in tumor resection rate and facial auditory nerve function rate, and have obvious advantages in operation time, intraoperative bleeding, average hospitalization days and postoperative recovery, and minimally invasive incision is more humane and has better and faster postoperative recovery.