Abstract： Objective To explore the protection of the facial-acoustic nerve during microsurgery for acoustic neuroma via the suboccipital retrosigmoid approach. Methods The clinical data of 25 cases with acoustic neurinoma treated by the suboccipital retrosigmoid approach were retrospectively analyzed. Results Total removal was achieved in 22 patients and subtotal in 3 patients. 20 with Cochlear nerve anatomic preservation at 2 weeks after surgery and 3 patients with effective hearing and 13 patients lost effective hearing but retained measurable hearing and 9 patients completely lost hearing( the New Hannover Classification V grade). The facial nerve was preserved anatomically in 18,H-B Grade I ～ IV in 15,Grade V ～ VI in 10. There were not cerebrospinal fluid leakage, intracranial infection and death in all cases. Conclusion When operating,the relation between the tumor and the important structure surrounding could should be understood fully. Then removed the tumor piece by piece with microsurgical techniques. That the effective way to keep the facial nerve and its function being protected,and could improve the prognosis of the operation.