Lateral, supine, and semi-sitting positions are commonly used in vestibular schwannoma surgery. The lateral position, also known as Fukushima position, allows access to the cerebellopontine angle and combines satisfactory surgical exposure with anesthesiological safety. The main advantage of the supine position is that it requires little manipulation of the patient and the tubes. The semi-sitting position is a modern variant of the original sitting position and allows optimal exposure as the intracranial pressure decreases and the gravity ensures better drainage of blood and CSF away from the surgical field. No randomized trials have been conducted to determine which position is the best; all of them are safe but may not be appropriate in all the cases. The surgeon’s experience and preferences may strongly impact on the intra- and postoperative outcomes, even more than the intrinsic characteristics of the position itself. As a consequence, patient positioning should be based on surgical team preference.