In part one, the management options available for vestibular schwannoma (VS) have expanded and a nuanced approach to the decision-making pathway is required. Patient factors influencing decision making include age, frailty, hearing status, dizziness, tumor size, morphology and growth kinetics, temporal bone anatomy and personal preferences. A case-based discussion of the impact of these factors on the treatment algorithm will be conducted. Discussion will focus in these patient scenarios about how these factors are used to recommend observation, radiosurgery or microsurgery. Each treatment choice is associated with benefits and risks which will be discussed in detail. Radiosurgery has been used for treatment of VS since the 1960s and is an excellent choice for some patients. The rationale and a description of treatment planning will be presented. The open surgical approaches with the risks and benefits will be explored including operative videos. The multidisciplinary team counseling the patient is often guided by their training and experience; the panel consists of members with diverse training and practice backgrounds who will explore differences of opinion on various treatment options. The components and dynamics of a successful skull base team will be discussed as well. In part two, the management options available for vestibular schwannoma (VS) have expanded and a nuanced approach to the decision-making pathway is required. Care for the VS patient does not end after any of these treatment options are pursued. Post therapy (or observational) management of VS sequelae are also particularly important to long term patient success. The management of these problems involves a strong multidisciplinary team approach including hearing rehabilitation, vestibular therapy and facial nerve reanimation when necessary. Vestibular dysfunction in both the short and long term requires intervention to allow the patient to return to their daily activities. Vestibular therapy can greatly enhance and speed a patient’s recovery and will be discussed by a licensed and certified vestibular therapist. When hearing is compromised by the VS or treatment, rehabilitative hearing options are also appropriate to discuss with the patient including various forms of amplification, osseointegrated devices and possibly electrical stimulation of the auditory system via cochlear implantation or auditory brainstem implant. Facial nerve dysfunction after treatment is a devastating outcome for patients, however numerous options for improved function and cosmesis are available and will be discussed by an expert in facial reanimation. A case-based approach will be discussed during the panel.