A comparative study of the suboccipital and translabyrinthine approaches for acoustic neuroma removal in 91 cases using a otologic–neurosurgical team is presented. Fifty of these cases involved the suboccipital route using microsurgical techniques; the remaining cases involved the standard otologic routes. The same neurosurgeon participated in all 91 cases. Two otologists participated in the study. The results of our series of cases indicate that the suboccipital route is the procedure of choice for acoustic neuroma removal.