ObjectiveTo study the anatomicopathological relation between facial nerve (FN) and acoustic neuronoma (AN) and summarize the techniques of how to protect facial nerves in microsurgery. MethodsA retrospective analysis of 585 patients with acoustic neuronmas treated by microsurgery for the first time between January 2007 and March 2012 was carried out. Anatomicopathological relation between FN and AN and protection of the facial nerve were described. ResultsThe tumors were totally removed microsurgically in 552 patients, and the total removal rate was 94.4%. Subtotal removal was performed in 33 patients. Facial nerve was anatomically preserved in 558 cases, and the rate of facial nerve preservation was 95.4%. After one-year follow-up, 549 patients had House-Brackmann Ⅰ-Ⅳ function. The location and shape of the FN along the tumor was identified as the follows: FN displaced along the ventral and superior surface of the tumor in 279 patients (47.7%), the ventral and central in 243 (41.5%), the ventral and inferior in 33 (5.6%), the dorsal in 10, the superior pole in 6, the inferior pole in 3, and FN surrounded in 11. ConclusionGood understanding of the meaning of anatomicopathological relation between FN and AN, intraoperative monitoring and perfect microneurosurgical skills are important in achieving the goal of total resection of acoustic neuromas and anatomic reservation of the facial nerve.