Stereotactic radiosurgery is now a reference treatment for small-to-medium-sized vestibular schwannomas. It provides excellent tumor control with low associated morbidity. The preservation of auditory and vestibular function remains a major concern and largely depends on dosimetric optimization, particularly the reduction of the dose delivered to the cochlea and vestibular system. Recent advances in understanding the radiobiological tolerance of these structures, coupled with technological innovations (high-resolution imaging, modern radiosurgery platforms, and artificial intelligence tools), allow for more precise and personalized treatment planning. Together, these innovations enhance therapeutic efficacy while minimizing toxicity.