Summary:The middle cranial fossa (MCF) approach for acoustic neuromas has been criticized for limited exposure, anatomic surgical difficulty, and increased risk to facial nerve and temporal lobe. From 1986 to the present, 49 patients' acoustic neuromas were removed via the MCF approach. Hearing was preserved or improved in 69% of patients regardless of preoperative hearing levels, and facial nerve function was Grade II or better in 94%. Both results demonstrate improvement improvement from our report 8 years ago. In addition, all patients are without recurrence. Our results continue to demonstrate the surgical advantages of the MCF approach and that, in experienced hands, it is as efficacious as other hearing preservation approaches.