Background: Vestibular schwannoma (tumor of the eighth cranial nerve) is a benign WHO grade I neoplasm arising from Schwann cells, most commonly located in the internal auditory canal and the cerebellopontine angle, and may lead to hearing loss, balance disturbance, and neurological complications in large tumors. 

Population-based data from CBTRUS (USA, 2004–2016) reported an incidence of 0,82 – 5,2/100,000, with predominantly unilateral tumors (~99.2%) and rare bilateral tumors (~0.8%); bilateral disease suggests NF2 and complicates management. 

Objective: To summarize evidence on epidemiology, tumor location, surgical indications, surgical approaches, facial nerve/hearing preservation outcomes, complications, and the role of the auditory brainstem implant (ABI) in vestibular schwannoma management.

Methods: A structured literature review was conducted. Data were extracted and synthesized from clinical studies, meta-analyses, and case series, and organized into evidence tables covering epidemiology, tumor characteristics, indications for surgery, surgical approaches, postoperative outcomes, complications, and outcomes of tumor resection combined with ABI. 

Results: Common indications for surgery included tumors ≥3–4 cm or Koos III–IV, growth >2–3 mm/year on MRI, brainstem/fourth-ventricle compression, progressive neurological symptoms, cystic tumors, failure of radiosurgery/observation, or the NF2 setting. 

Comparative syntheses suggested that the translabyrinthine approach may be associated with shorter length of stay and better facial nerve outcomes than retrosigmoid in some analyses, while approach selection depends on tumor size/location and the goal of hearing preservation. 

Large series reported facial nerve preservation (House–Brackmann I–II) of approximately 82–93% and hearing preservation (AAO-HNS class A–B) of approximately 42–61%, varying with preoperative hearing status and patient cohorts. Frequently reported complications included facial palsy and cerebrospinal fluid (CSF) leakage (often 3–5% in some series), with the literature showing a range of 0–13.5% for CSF leak. 

In NF2 patients, tumor resection combined with ABI may improve hearing-related measures in selected reports (e.g., improved PTA and ABI use rates at 1 year). 

Conclusion: When appropriately indicated, vestibular schwannoma surgery can achieve high facial nerve preservation and good tumor control. Standardized outcome reporting (HB and AAO-HNS), optimized prevention/management of complications, and consideration of ABI in NF2 or when cochlear nerve function is lost are recommended.