Division of the seventh nerve during acoustic tumor removal cannot always be avoided. Direct VII-VII neuroanastomosis is superior to any other neuroanastomosis for facial reanimation. Rerouting of the seventh nerve from the mastoid and neuroanastomosis can be accomplished primarily at the initial surgery. This study reviews 19 patients with a follow-up of greater than 18 months who underwent the procedure at the time of tumor removal because of seventh nerve involvement by tumor, intentional sacrifice or, rarely, unintentional division. A House class IV result or better, without the twelfth nerve neurological deficit produced by a VII-XII neuroanastomosis, was achieved in 16 of 19 patients. Although the technique is not new, surgeons unprepared to manage this surgical complication at primary tumor removal should either learn the technique, work with an associate who can do so, or be prepared to call in someone else to do it.