Abstract: The anatomy of the lateral skull base is very complicated, which supports the brain upwards and connects the neck downwards with a large number of crucial structures passing through, including important blood vessels, nerves, and vestibular and auditory apparatuses. The basic principle of lateral skull base surgery is resecting the lesion and meanwhile preserving the function of important tissue and organs. With the development of interventional medicine, neuromedicine and facial nerve surgery, protection of important nerves and blood vessels of the skull base has made significant progress, and fatal complications and neurological defects have been greatly reduced. However, the protection of auditory function is not ideal, which has gradually become a research hotspot. The selection of appropriate treatment and surgical approach, the usage of endoscopic techniques, intra-operative auditory electrophysiology monitoring, and intraoperative reconstruction of the auditory function are all very critical for hearing protection.