Summary:A century of operative case reports and series of acoustic neurinomas covering the years 1890‐1990 were reviewed with respect to surgical approach, operative mortality, and preservation of cranial nerves VII and VIII. We reviewed 127 series that included 10,967 patients. The series were chronologically subcategorized into five historical eras. Cumulative operative statistics were calculated for the major operative approaches of each era. This review provided an overview of acoustic surgery progress, and allowed the detection of trends in the operative results of different surgical approaches. Analysis of the cumulative operative statistics of the major surgical approaches in the most recent era of acoustic tumor surgery provides potential decision‐making guidelines for optimizing acoustic tumor management.