Objective: To retrospectively study the outcomes of vestibular schwannoma (VS) resection. Methods: Between January 2003 and December 2006, 103 consecutive patients who had undergone VS resection were included in this study. Medical records, operation summaries, follow-up data, and neuroradiological findings were analyzed. The relationship between tumor size, location, and topography relative to the facial nerve bundles was studied for a mean duration of 16 months (range: 3-39 months). Results: Complete tumor resection in combination with anatomic preservation of the facial nerve was achieved in 101 (98.1%) cases. The facial nerve was fully preserved in 100% of cases with small or medium tumors and in 37/39 patients with large tumors. Overall, 83.5% of patients had normal or near-normal facial nerve function 3-12 months post-surgically. The mortality rate was 0%. Conclusions: Even in large VS, preservation of facial nerve function (H-B Grade I or II) should be prioritized over total resection. For tumors > 3 cm, the goal of low morbidity and maintenance of normal facial nerve function can be attained with the retrosigmoid transmeatal approach, refined microsurgical technique, and intraoperative facial nerve monitoring. (c) 2008 Published by Elsevier B.V.