Abstract： Objective To evaluate the advantages of transotic approach in acoustic neuroma surgery.Methods A retrospective analysis of patients with acoustic neuroma in our hospital between July 2007 and March 2012 were performed.These patients were undergone evaluation of PTA,facial nerve function,temporal bone CT,inner ear MRI before operation.There were 32 patients,who have a hearing loss more than 50 dB,or a tumor size larger than 2 cm,which made the preservation of hearing function impossible.Low middle cranial fossa,forward sigmoid sinus and high bulb of jugular vein were showed in preoperative CT scan.These patients were picked to have acoustic neuroma resection by transotic approach.Results The radical tumor resection rate was 94％ (30/32).The facial nerve structure prescrvation rate was 100％.After the surgery,all patients were single -side deaf.Some patients experienced vertigo,which was relieved after treatment.There was no severe complication such as death,hemiplegia,or intracranial infection.However,there were one case of intracranial hemorrhage and one case of cerebrospinal fluid leakage,which were cured by revision surgery.Conclusions For those who has a worse pneumatolytic temporal bone,which presents with low middle cranial fossa,forward sigmoid sinus and high bulb of jugular vein in CT scan,if it is impossible or there is no need for the preservation of the hearing function,the transotic approach may be considered for better radical removal of tumor,preservation of facial nerve and reduction of cerebrospinal fluid leakage.