Surgical resection stands as one of the potential therapeutic methods for vestibular schwannomas (VS). However, in the management of patients with VS, there is limited literature directly comparing the Retrosigmoid approach (RSA) with the Translabyrinthine Approach (TLA) and Middle Fossa Approach (MFA). This gap arises because the MFA is typically reserved for smaller intracanalicular tumors, while the RSA and TLA are preferred for larger lesions. Our objective was to assess and compare the outcomes and safety profile of these three different surgical approaches. A comprehensive search was performed on PubMed, Embase, and Cochrane Library for studies comparing RSA with TLA and MFA in patients with VS. The main outcomes of interest were hearing preservation, facial nerve function, extent of resection, and postoperative complications. Statistical analyses were performed using Review Manager. The I