Introduction: The correlation between gender and likelihood of preservation of serviceable postoperative hearing in acoustic neuroma surgery has seldom been reported. The limited available data suggest that, when preoperative tumor size and hearing are comparable, males have a greater likelihood of preservation of some postoperative hearing (p < 0.05 at best). Methods: A consecutive series of 184 retrosigmoid procedures for removal of unilateral acoustic neuromas (AN), in the period ending June 30, 2005, were subjected retrospectively to linear regression analysis for factors predictive of successful postoperative preservation of Gardner and Robertson Class 1 and 2 hearing (HP). These cases were selected on the basis of size (mean extracanalicular diameter < 20 mm) and preoperative hearing, and form part of a larger series of 810 consecutive cases of unilateral AN. Variables examined included age, gender, side and size of tumor, preoperative hearing, and intraoperative cochlear nerve compound action potential (CAP) threshold shift. Results: Overall HP rate was 34.4% (53.8% for intracanalicular AN). Size (p < 0.001), intraoperative CAP threshold shift (p < 0.0001), and female gender (p = 0.01) were predictors of HP. Male-female ratio for the series was 47/53. Age (p = 0.37) and tumor size (p = 0.20) did not differ between males and females. Postoperative HP occurred in 25.4% of males and 44.2 % of females, respectively (p = 0.01). Conclusions: Though female gender has not previously been identified as a predictor of greater likelihood of preservation of serviceable postoperative hearing in AN surgery, the present study strongly suggests that this is the case. Gender difference should probably be taken into account in preoperative discussion of outcome, at least in our hands, and may have other implications as well.