Objective To investigate the application of microsurgical treatment in acoustic neuroma after gamma knife radiotherapy, and to share the experience of Department of Neurosurgery in Xiangya Hospital.Methods The patients with acoustic neuroma who underwent surgical resection performed by Professor Yuan Xianrui in Department of Neurosurgery in Xiangya Hospital of Central South University were enrolled as gamma knife radiotherapy (GKR) group, and a control group was established. The two groups were compared in terms of clinical features and preservation of neurological function.Results There were 14 patients each in the GKR group and the control group. Severe adhesion between tumor and surrounding nerves and vessels was observed intraoperatively in the GKR group. The GKR group achieved a rate of total tumor resection of 92.9% and a rate of facial nerve preservation of 100%, while the control group achieved 100% for both rates. The control group had a significantly better long-term facial neurological function than the GKR group.Conclusions Total resection of acoustic neuroma after GKR can still achieve a satisfactory effect, but such patients have a poorer facial neurological function than those who do not undergo radiotherapy. For previously untreated patients with acoustic neuroma, clinicians should carefully choose gamma knife radiotherapy, and surgical treatment is still the preferred regimen.