Objective To evaluate the clinical effect of microsurgical resection of acoustic neuroma via the suboccipital retrosigmoid transmeatal approach in combination with intraoperative neurophysiological monitoring.Methods A retrospective analysis was performed on the clinical date of 98 patients with acoustic neuroma, who were treated by microsurgical resection via the suboccipital retrosigmoid transmeatal approach in combination with intraoperative neurophysiological monitoring.Results Of all cases, 96(97.9%) underwent total resection of the tumor, and 2(2.1%) underwent subtotal resection. The facial never was anatomically preserved in all cases (100%); the petrosal vein was anatomically preserved in 95 cases (96.9%); hearing was preserved in 14 cases (14.3%). No deaths were reported.Conclusions Microsurgical resection of acoustic neuroma via the suboccipital retrosigmoid transmeatal approach in combination with intraoperative neurophysiological monitoring can achieve a satisfactory clinical outcome.