In a series of 120 patients with acoustic neurinoma, hearing preservation at removal of the tumour via the suboccipital approach was attempted in 30 ears. Hearing was preserved in 13 ears (43%), but in two, hearing was lost entirely in 3 to 4 years; thus the success rate was 36%. In 9 of the remaining 11 ears useful speech discrimination was present. Audiological tests showed increased retrocochlear loss after surgery. A surgical team should master the methods of both translabyrinthine and suboccipital surgery in order to choose the best approach for each patient.