There is a consistent set of relationships on the brainstem surface facing an acoustic neuroma that provides the basis for identifying the displaced facial nerve on the medial side of the tumor. This review of the microsurgical anatomy of the brainstem surface facing an acoustic neuroma is based on the examination of the side of the brainstem during 42 operations for the removal of acoustic neuroma, and on the study of 50 cadaveric brains in the microsurgery laboratory. In the operative series, which included many large tumors, the facial nerve was preserved at operation in over 90% of the 42 patients. There was no mortality, and no need for cerebellar resection to remove the tumor in any patient.