The complications of acoustic neuroma (AN) surgery by the extended middle cranial fossa approach were studied in 160 cases. Death during surgery occurred in 3 cases (1.9%); 2 of these involved large tumors and the third was a case of recurrence. Transient temporal lobe symptoms were seen in 24 cases (15.3%); the average tumor diameter in these cases was 36.0 mm. Beside symptoms of 7th and 8th nerve disturbance, hemiparesis was seen 7.6%; 3rd, 4th, and 6th cranial nerve symptoms in 7.0%; and cerebellar symptoms in 7.6% of the patients. The incidence of these disturbances increased with tumor size. Cerebrospinal fluid (CSF) leakage occurred in 20.4% of the cases and this necessitated surgical treatment in 5% of the cases.