BACKGROUND: Cerebral vasospasm is an important cause of morbidity after subarachnoid hemorrhage, but can also occur after resection of acoustic neuroma. This study aimed to identify factors associated with postoperative cerebral vasospasm in patients with acoustic neuroma. METHODS: This was a retrospective analysis of patients with acoustic neuroma (diagnosed by preoperative magnetic resonance imaging and postoperative pathology) treated between April 2013 and February 2014 in a hospital in China. Patients with other intracranial abnormalities, postoperative vasoactive drug use, or postoperative abnormalities in consciousness, vital signs, blood electrolytes, or arterial blood gases were excluded. The neurilemmoma was removed using the suboccipital retrosigmoid sinus approach, with care taken to minimize bleeding and protect the facial, trigeminal, and lower cranial nerves and brainstem. Flow velocities in the bilateral internal carotid, middle cerebral, and anterior cerebral arteries, assessed with transcranial Doppler ultrasonography before surgery and on postoperative days 1, 3, 5, 7, and 9, were used to detect cerebral vasospasm (mild, 120-140 cm/s; moderate, 141-200 cm/s; severe, >200 cm/s). Factors associated with vasospasm were identified by univariate and multivariate analyses. RESULTS: Forty-three (53.8%) of the 80 patients (36 men) included were diagnosed with cerebral vasospasm: 5 (11.6%) were categorized as mild, 36 (83.7%) as moderate, and 2 (4.7%) as severe. Multivariate analysis showed that younger patient age, larger tumor size, and firm tumor consistency were independently associated with postoperative cerebral vasospasm (P < 0.05). CONCLUSIONS: Younger patient age, larger tumor size, and firmer tumor consistency were independently associated with postoperative cerebral vasospasm in patients with acoustic neuroma.