The preferred setting for the treatment for vestibular schwannoma these days is multidisciplinary and multimodal. A balance has to be struck between a wait-and-scan attitude and a more active approach (surgery or radiotherapy). An initial wait-and-scan attitude is a reasonable management option because many tumours do not grow during a prolonged period of observation. The different surgical approaches may or may not involve attempts to preserve hearing. Stereotactic radiotherapy as treatment of choice is often considered in the elderly patient presenting with a vestibular schwannoma smaller than 2.5 cm with documented growth. This paper will review current treatment modalities and the respective pros and cons. A decisional algorithm as currently adopted by our skull base team is presented at the end of the paper.