To evaluate and present the treatment strategy and hearing preservation in a recent series of vestibular schwannoma cases. A retrospective analysis of 200 patients operated consecutively over a 3 year period was performed. Patient records, operative reports, including data from the electrophysiological monitoring, follow-up audiometric examinations, and neuroradiological findings were analyzed. The anatomical integrity of the cochlear nerve was preserved in 75.8% of the cases. When only patients with preserved preoperative hearing were included, the rate was 84%. The overall rate of functional hearing preservation was 51%. It was highest in small tumors--60% in class T1 and 72% in class T2. In tumors extending to and compressing the brain stem, preservation of some hearing was possible in up to 43%. Vestibular schwannomas are benign lesions whose total removal leads to definitive healing of the patient. The goal of every surgery should be functional preservation of all cranial nerves. Using the retrosigmoid approach with the patient in the semi-sitting position, hearing preservation is possible even for large schwannomas.