Abstract From 1997 to 2002, 55 patients with vestibular schwannomas (VS) were managed by radical removal in a one-stage procedure by a retromastoideal posterior fossa approach. Ninety percent of VS were of the 4th grade compressing the brainstem. The described group proves that a high standard of microsurgical technique and intraoperative neurophysiologic monitoring of cranial nerve function is essential. Small VS can be removed without any injury to the facial nerve and with subsequent serviceable hearing. Large VS can be removed with fairly good facial nerve function or with a temporary functional lesion. Less than 10% of operated VS necessitated a facial nerve reconstruction in a cerebellopontine angle (CPA). Cross anastomosis between nerves was never used. No serviceable hearing was maintained after surgery of large VS. Majority of VS in our group (90%) were not suitable for stereoradiosurgery (SRS) because of the size. Five patients operated on for a rapid growth after previous SRS proves that radiotherapy should not be a method of the first choice in VS. Our study supports an opinion that growing VS should be treated in the earliest possible stage. Total removal can be achieved with minimal morbidity and mortality. Auditory brainstem implant (ABI) brings a new chance of maintaining hearing in five patients with neurofibromatosis 2 (NF 2) and bilateral VS.