Objective To explore the application of electromyographic monitoring in acoustic neuroma surgery.Methods Electromyographic data of the orbicularis oculi and orbicularis oris recorded during surgery using needle electrodes were collected from acoustic neuroma patients admitted from January 2016 to December 2017. The prediction of facial nerve function after surgery by spontaneous muscle activity (SMA) such as A trains was analyzed.Results Sixty-one patients underwent monitoring of SMA in the facial nerve. The anatomy of the facial nerve was preserved during surgery. In those patients, 53 had SMA detected, consisting of 33 with A trains and 20 with other types of SMA. In the two groups of patients, 21 and 7 patients had facial nerve function injury one week after surgery, suggesting a significant difference in short-term facial nerve function injury between the two groups (P=0.043); 16 and 5 patients underwent facial nerve function injury one year after surgery, suggesting that there was no significant difference in long-term facial nerve function injury between the two groups (P=0.090).Conclusions Monitoring SMA during surgery can help surgeons locate the facial nerve and reduce its iatrogenic injury. Compared with other types of SMA, A trains has a significant value in predicting short-term (1 week) facial nerve function injury after surgery but not in predicting long-term (1 year) facial nerve function injury after surgery.