Earlier diagnosis and cooperation with allied specialists in neurosurgery have lessened complications of acoustic tumor surgery. To date, complications cannot always be prevented. The controversy over which approach is best for acoustic tumor extirpation still continues. While teams must answer this question themselves, our experience favors the transtemporal approach. Of the potential disabilities from this operation, facial paralysis or its sequelae remain the most frequent. The transtemporal approach gives a more accurate anatomical definition of the facial nerve. Efforts to preserve hearing (especially with tumors 2 cm or larger), when matched with the potential sequelae of facial paralysis, may prove futile.