Preserving facial nerve function is of prime importance in acoustic neuroma surgery. A comprehensive knowledge of anatomy, experience and surgical precautions can reduce the incidence significantly. Important considerations are when and how to repair if injury occurs. Several options include: primary end-to-end anastomosis (ideally done at the time of primary surgery); cable nerve graft interposition; and hypoglossal-facial XII-VII nerve anastomosis (usually done when the damaged site is not obvious or more than six months have elapsed after the palsy). In this study three surgical techniques of 14 patients who underwent XII-VII anastomosis were compared. The techniques were end-to-end, end-to-side and split anastomoses, and evaluation was based on facial outcomes and tongue morbidity one year post surgery. Facial palsy and tongue atrophy after anastomosis were evaluated using the House-Brackmann and Martins grading systems. As expected, end-to-side subgroup patients had worse postoperative facial function but best tongue (least tongue atrophy) outcomes and in the end-to-end group the tongue outcomes (least tongue atrophy) were the worst and the facial outcomes the best. It is evident from this study that maybe the split nerve anastomosis is the best trade-off for the two outcomes (although numbers are too small to make a definitive conclusion on this). This is a useful study, however there were small numbers and unequal distribution in each subgroup.