Abstract: Objective: To assess the value of neurophysiological monitoring in preserving the facial nerve in microsurgery for acoustic neuroma. Methods: Forty-six patients with acoustic neuroma were divided into monitoring group and non-monitoring group. The tumor was removed under the microscope without intraoperative facial nerve monitoring in 22 cases and with intraoperative monitoring in 24 cases. All the patients were followed up. Results: House-Brackmann system was used to evaluate the function of the facial nerve 3 months after the operation. Among the 24 cases in monitoring group,grade Ⅰ was observed in 21 cases,grade Ⅱ in 2 cases and grade Ⅲ in 1 case; among the 22 cases in non monitoring group,grade Ⅰ was observed in 13 cases,grade Ⅱ in 5 cases,grade Ⅲ in 2 cases and grade Ⅴin 2 cases. The difference was significant(P < 0.05). Conclusions: Neurophysiological monitoring may effectively preserve the facial nerve function in microsurgery for acoustic neuroma.