Auditory neuroma is a benign tumor originated from the vestibular nerve sheath membrane cells, located in the internal auditory canal and the bridge cerebellar angle area of the brain, often compressing the auditory nerve during the slow growth process, resulting in tinnitus, hearing loss and other symptoms, and by the time the tumor grows up and symptoms worsen and new nerve compression symptoms appear, the tumor’s prolonged pressure often leads to the complete loss of one side of the hearing. However, with the improvement of health awareness and the advancement of imaging tests, early detection of acoustic neuroma has become more and more common, and a small number of acoustic neuromas still have effective hearing at the time of detection. Since most acoustic neuromas compress the brainstem and the auditory, facial, and vestibular nerves are concomitantly out of alignment, surgery to remove acoustic neuromas needs to protect the brainstem, nerves, blood vessels, and other important structures to minimize possible functional impact. With the advancement of microscopic neurosurgical techniques, the surgery for acoustic neuroma has progressed from protecting important structures such as the brainstem to protecting the structure and function of the facial nerve on the basis of this, and nowadays, under the monitoring of neurophysiology, the anatomical structure of the facial nerve can be preserved in the majority of cases, and the nerve function is not much affected after the resection of most of the acoustic neuromas. However, neurosurgeons are still in the process of restoring and preserving hearing after the removal of an acoustic neuroma. For the cases where the hearing has been completely lost or no measurable hearing exists before surgery, the long-term compression of the tumor has caused the loss of function of the auditory nerve, and even if the tumor is removed surgically, the function of the auditory nerve and the hearing can not be restored, and one can only rely on the normal hearing on the opposite side of the tumor to listen to things. For patients who still have measurable hearing before surgery, they should try their best to preserve their hearing during the surgery, but unfortunately, hearing preservation is still a difficult problem for this kind of patients. Many patients lose their hearing after the surgery of acoustic neuroma, and only some of them still retain their effective hearing after the removal of acoustic neuroma. For hearing patients, surgical removal of the tumor while preserving hearing remains a challenge. For patients with auditory neuromas, special attention should be paid to hearing examination before surgery, such as pure tone audiometry, auditory brainstem response, speech recognition rate, etc., to determine whether there is any measurable hearing or functional hearing. The goal of the surgery for removal of auditory neuromas with hearing is not only to preserve the structure and function of the nerves, but also to try to preserve the function of the hearing.