Small-sized vestibular schwannomas are those that occupy only the internal auditory canal (intracanicular) or protrude very discreetly into the cerebellopontine angle, in other words, the degrees T1 and T2 tumors according to the Matties and Samii classification, as well as grades I and II of the Koos classification. Small-sized vestibular schwannomas can be treated with microneurosurgical excision, stereotactic radiosurgery, or observation. Transmeatal access serves as the basis for microneurosurgical resection through a retrosigmoid approach. In this chapter, the microsurgical anatomy of the internal auditory canal and the stages of the transmeatal access are described in detail. The selection of the most appropriate treatment technique for each patient is reviewed, as well as the results, outcomes, and complications. The goal of treatment is to maintain effective hearing and facial nerve function, and all treatment modalities have a reasonable functional prognosis.