The risk of facial nerve palsy after microsurgical removal of vestibular schwannoma cannot be totally eradicated. Beyond the functional problem, patients have to overcome the consequences of cosmetic disturbances, particularly the psychosocial difficulties and the decrease in quality of life due to this palsy. Taken together, the data from our personal experience and analysis of the literature indicate that the major predictor of postoperative facial deficit is tumor size. This information must be given to the patient when counseling for treatment option. When confronted with large tumors, we personally changed our surgical goals and considered that facial nerve conservation and tumor control are interconnected priorities instead of radical removal.