The retrosigmoid approach is most commonly performed in vestibular schwannoma surgery regardless of the tumor size, especially when hearing preservation is attempted; it is a safe option for small tumors, with low morbidity and good facial nerve and hearing preservation outcomes. A retroauricular C-shaped skin incision is performed after patient preparation and positioning. Keyhole retrosigmoid craniotomy follows, so as to expose sigmoid and transverse sinuses and the dura mater of the posterior fossa, which is then incised. The CSF within the lateral medullary cistern is drained to obtain cerebellar retraction. The internal auditory canal (IAC) is opened under direct microscopic observation. The facial nerve is localized and traced by means of intraoperative neurophysiological monitoring devices. The capsule is elevated and incised to achieve satisfactory tumor debulking. The portion of the tumor within the IAC is removed piecemeal, and the tumor capsule is dissected away from brainstem and cranial nerves.