Objective <p>Cerebrospinal fluid leak can occur after retrosigmoid craniectomy and lead to substantial patient morbidity. The aim of this study was to compare two closure techniques for vestibular schwannoma resection in terms of cerebrospinal fluid leak and other procedure-related issues.</p> Methods <p>This retrospective monocentric study included patients who underwent surgery for vestibular schwannoma resection via a retrosigmoid approach by the same oto-neurosurgical team. Before 2019, the retrosigmoid approach consisted of a craniectomy and the closure involved autologous abdominal fat graft obliteration (previous procedure). After 2019, the authors performed a craniotomy and used S53P4 bioactive glass granules to close the craniotomy site (new procedure).</p> Results <p>We included 193 patients, 79 with the previous procedure and 114 the new procedure. Cerebrospinal fluid leak developed postoperatively in 3 patients with the new procedure and 14 with the previous procedure (<i>p</i> &lt; 0.01). Need for surgical revision to treat the leak was lower with the new than previous procedure (1 vs 6 patients, <i>p</i> = 0.02) and the median length of hospital stay was reduced by 2&#xa0;days with the new procedure (&lt; 0.001).</p> Conclusion <p>The craniotomy/bioactive glass obliteration technique was associated with less cerebrospinal fluid leak as compared with craniectomy/autologous fat graft obliteration, less revision surgery and a shorter hospital stay.</p>