Auditory neuroma originates from the sheath of the auditory nerve and is a typical nerve sheath tumor, since there is no involvement of the auditory nerve itself. Auditory neuroma is inappropriately named: auditory nerve sheath tumor. This tumor is one of the common intracranial tumors. The tumor occurs in middle-aged people, with a peak in the 30’s and 50’s, and the youngest at 8 years of age, and the highest age can be over 70 years of age. Most of the tumors occur in the vestibular section of the auditory nerve, and a few occur in the cochlear section of the nerve. With the growth of the tumor, patients gradually develop some symptoms. Early stage is tinnitus and deafness; middle stage is facial nerve or trigeminal nerve symptoms, such as facial paralysis and trigeminal neuralgia. In the middle stage, symptoms of facial nerve or trigeminal nerve, such as facial paralysis, trigeminal neuralgia. In the late stage, physical symptoms caused by the pressure on the brainstem, such as hemiplegia or even limb paralysis. In advanced stage, if combined with hydrocephalus, the patient may even die of sudden coma. Most of the tumors are unilateral and a few are bilateral. It is a benign lesion, and if it can be detected at an early stage and the tumor is completely cut, it can often be permanently cured. However, due to the proximity of the tumor to important structures such as the brainstem, surgical resection is a great challenge for neurosurgeons. The surgical treatment of acoustic neuroma has a history of more than 100 years, which can be summarized as the following stages: (1) Pioneer stage: Von Bergmann first tried to resect the acoustic neuroma through the suboccipital approach in 1890, and at that time, he even used his fingers to peel off the tumor, and due to the difficulty in controlling the bleeding, the mortality rate of the operation was as high as 100%. Cushing opened a new era of surgical treatment of acoustic neuroma. In 1917, a group of patients with acoustic neuroma reported that their surgical mortality rate was 15.4%, and the total average surgical mortality rate at that time was reduced to 33.9%. (2) Therapeutic stage: From 1925 to 1960, the surgical treatment of acoustic neuroma was in the stage of surgical treatment. During this period, antimicrobial agents began to be widely used in clinical practice, and the surgical instruments were constantly improved, especially the development of bipolar coagulant and anesthesia technology, which made acoustic neuroma enter into the stage of surgical treatment. The representative of this period was Dandy, who firstly reported the total resection of acoustic neuroma in 1925, and by 1940, he reported that the mortality rate of acoustic neuroma surgery had been reduced to 10%, and most of the tumors could be totally resected. (3) Facial nerve preservation stage: In 1961, House firstly introduced microsurgical techniques into auditory neuroma surgery, which brought the surgical treatment of auditory neuroma into the stage of facial nerve preservation. Surgical microscope, microsurgical instruments, bipolar electrocoagulation, neurophysiological monitoring and neuroimaging techniques became more and more mature, especially the introduction of CT in 1972, which led to revolutionary changes in neuroimaging. 1961 to 1974, not only total resection of acoustic neuromas was possible, but also preservation of the facial nerve was also possible, and the mortality rate of the operation was reduced to 8%, and the rate of total tumor resection reached 83.6%, and that of anatomical preservation of the facial nerve reached 79.3%. The total tumor resection rate reached 83.6%, and the anatomical preservation rate of facial nerve reached 79.3%. ( 4 ) Hearing preservation stage: In the past 30 years since 1975, the surgery of acoustic neuroma has entered the stage of hearing preservation. High-resolution CT and MRI are widely used in clinic, which enable early diagnosis of small tumors confined to the internal auditory canal. Especially in the past 10 years, the application of three-dimensional imaging technology, intraoperative navigation equipment, ultrasonic suction, electromagnetic knife, endoscopy and other high-tech products have reduced the average mortality rate of acoustic neuroma surgery to 1.8%, and the rate of total tumor resection to 93.5%, with the anatomical preservation of the facial nerve up to 87.5%, but the hearing preservation rate is still low. Experienced surgeons have better surgical outcomes. For example, Samii reported in 1997 that for 1,000 cases of acoustic neuromas, the total tumor resection rate was 97%, the operative mortality rate was 1.1%, the anatomical preservation of the facial nerve was 93%, and the anatomical preservation of the cochlear nerve was 68%. At present, it is still difficult to preserve hearing in the surgery of removing auditory neuroma. In addition to the factors of tumor size, the degree of nerve involvement, and surgical equipment, more importantly, it also lies in the neurosurgeon’s experience and surgical skills. Experienced specialists have a significantly higher rate of hearing preservation than general specialists. In addition, the hearing mentioned here should be effective hearing, not simply having hearing. For example, if some patients have obvious tinnitus, although they have hearing, but they are “buzzing” all day long, it is meaningless. The future direction of the treatment of acoustic neuroma, not only to preserve the facial nerve, auditory nerve. It is also necessary to repair the damaged facial nerve and hearing. At present, countries around the world have carried out research in this area. The following case is one of the typical surgical examples of preserving facial nerve and effective hearing done by Director Yang Jun recently. The patient’s facial nerve and hearing were preserved by the removal of an acoustic neuroma, and good results were achieved. The above picture shows the patient’s MRI. The tumor is located in the right pontine cerebellar horn area, with a diameter size of about 1.5 cm. Before surgery, the patient had hearing loss on the right side. The above picture shows the comparison of the patient’s face before surgery, 2 days after surgery, and before discharge, which shows that the patient’s facial nerve function is intact. The frontal lines and nasolabial folds are symmetrical. The above figure shows the patient’s preoperative and postoperative pure tone audiometry checklist. It can be seen that the patient’s hearing under 1000 HZ is maintained at 20-50 decibels. This is basically consistent with normal hearing. The patient also had no tinnitus after surgery.