This report discusses a combined neurosurgical-otologic team approach to the management of 16 consecutive suspected VIII nerve neurinomas, all operated via the suboccipital route. A suboccipital craniectomy is done with the patient in the prone position. Dissection for all size tumors began with exposure of the internal auditory canal to the transverse crest with dissection of the neurinoma from the VII and VIII cranial nerves beginnin in the lateral most osterior portion of the internal auditory canal. There was one death and one cerebrospinal iuid (CSF) leak. Total tumor removal was accomplished in 14 of 15 acoustic neurinoma patients. Facial nerve function was preserved in 12 of 15 patients and preoperative hearing maintained in 5 of 15 patients.