Cochlear implantation in patients with vestibular schwannoma (VS) or neurofibromatosis type II (NF2) presents unique challenges in both indication and timing. Options include implantation with or without tumor removal, or delayed CI following attempted hearing preservation. Intraoperative cochlear trauma and delayed surgery may lead to ossification, requiring preventive strategies such as placement of a dummy electrode. Surgical technique resembles standard CI, but care must be taken to preserve imaging access for MRI surveillance. Ultimately, auditory outcomes are determined more by the integrity of the cochlear nerve than by surgical factors, with promontory testing being essential in predicting functional benefit. Intracochlear schwannomas (isolated or in the context of a NF2) comport different kinds of difficulties, mainly related to the necessity to preserve the anatomy of the cochlea occupied by the lesion. Different strategies are possible even in this situation, with the most adopted being tumor removal and simultaneous cochlear implantation through a subtotal petrosectomy with promontorium drill-out.