Objective To summarize the experience of intraoperative care for the patients undergoing microsurgery via retrosigmoid keyhole approach, so as to improve the treatment effect and minimize complications. Method The clinical records on the intraoperative care of 100 patients undergoing microsurgery via retrosigmoid keyhole approach were retrospectively analyzed. Result Using the keyhole technique and small incision, the cerebellopontine angle lesions were exposed clearly. Moreover, the proper intraoperational cooperation shortened the duration of operation, reduced bleeding and minimized postoperative complications such as cerebrospinal fluid otorrhea, intracranial infection, intracranial hemorrhage, and subcutaneous hydrops. Conclusion Proper operational postures and intraoperative cooperation can make full use of the limited space of the microsurgery via retrosigmoid keyhole approach and ensure the success of the operation.