Large vestibular schwannomas (Koos grade three or four) are traditionally treated by surgical resection. Gross total resection of such large tumours often results in facial nerve dysfunction. Hence facial nerve preservation surgery was introduced in which maximal surgical resection is attempted with a potential residual tumour capsule or nodules left behind in an effort to maintain facial nerve function. The authors of this paper retrospectively studied the outcomes of this technique in 52 patients. Their findings support facial nerve preservation surgery as the new standard for acoustic neuroma treatment. They suggest that maximising resection with close postoperative radiographic follow-up enables early identification of tumours that will progress to radiosurgical treatment. This sequential approach can lead to combined optimal facial nerve function and effective tumour control rates. Facial nerve preservation surgery seems to definitely reduce the morbidity following vestibular schwannoma resection.