Auditory neuroma is the most common cranial nerve tumor, which often manifests as tinnitus, deafness, vertigo, facial muscle twitching, tear reduction, and facial palsy. Compression of the brainstem and cerebellum can also lead to hemiparesis, unstable walking, difficulty in pronunciation, hoarseness, and difficulty in swallowing, etc. Once detected, it should be treated with early surgery. As the facial nerve and the auditory nerve are close to each other, the direct compression of the facial nerve by the tumor often causes the facial nerve to become extremely thin and difficult to recognize. Therefore, resection of auditory neuroma while preserving the facial nerve becomes a difficult point in the resection of auditory neuroma. In particular, postoperative facial palsy is the most common complication of surgery for giant auditory neuromas (up to 4 cm in diameter). At the same time, due to severe facial palsy eyelid cannot be closed and tear reduction, which often leads to exposure keratitis and vision loss in the affected eye, or even blindness. We followed the concept of precise minimally invasive application of microscopy and intraoperative electrophysiological monitoring, and the facial nerve preservation rate was greatly improved, and no permanent facial palsy occurred after surgery. Patient information: XX Zhang, female, 30 years old Symptoms: blurred vision for more than one year, nausea and vomiting in the past one month. He had a history of tinnitus for many years, the details of which are not known. He has had hearing loss in the left ear for more than 3 years and has completely lost hearing in the left ear. The left side of the face was painful and hyperalgesia Facial palsy grade 2. Preoperative MRI T1 showed a low signal occupancy in the left pontocerebellar horn region, compressing the brainstem Preoperative MRI T2 showed a high signal occupancy in the left pontocerebellar horn region, compressing the brainstem. T2 and enhancement films showed indistinguishable compressed quadrigeminal ventricles Microscopic visualization showed complete preservation of facial nerve after surgery Postoperative CT showed complete resection of the tumor and repositioning of the surrounding compressed displaced brain tissue, no brain tissue contusion or hemorrhage Postoperative pathology report: nerve sheath tumor, classic Immunohistochemistry: S-100 (+), Sox10 (+), PGP9.5 (scattered +), NSE (+) GFAP (+), Ki-67 (<5% +), nf (-)< span=""> See: House-Brackmann grading scale for facial palsy after auditory neuroma House-Brackmann grading scale for facial palsy after auditory neuroma http:///zhuanjiaguandian/haobinchanghai 71031594.htm