Because my AN was 4.5 cm when discovered, surgery was my only option. However, I was very concerned about post-op (a) facial paralysis and, (b) headaches. The neurosurgeon I was referred to (by another neurosurgeon who did not perform AN surgery) was highly experienced (30 years) and very respectful of my concerns. He flat-out assured me that his AN surgery patients "don't have post-op headaches" and he presented me with a plan to de-bulk the tumor (peeling off layers) and sever it's blood supply, then, following a 90 day 'rest', I would undergo radiation (FSR) to destroy the remaining tumor's ability to re-grow. This approach was intended to spare doing damage to the facial nerves and to "destroy the tumor's DNA", as my doctor put it, without doing harm to surrounding brain tissue. The neurosurgeon teamed with a very talented radiation oncologist to 'map' the radiation treatments (using a 'fresh' MRI and CT scans.) This mature neurosurgeon stated that he did not perform AN surgery unless the patient's tumor was too large for radiation, as mine was. This was proven some time later when I recommended him to another AN patient (via these forums). Because her AN was relatively small, after he viewed her MRI scan results, he promptly escorted her to the radiation oncologist's office and did not consider operating on her. She was a bit nonplussed because I had so highly recommended him but on reflection, I realized that the good doctor was simply being true to his word regarding the patients he operated on.
Long story short: the surgery was a resounding success. My pre-op symptoms (dizziness, loss of the sense of taste, stabbing pain on AN side) disappeared almost as soon as I awoke from the anesthetic. No headaches and no facial nerve complications, either. The follow-up radiation was uneventful but successful. Unfortunately, my hearing in the affected ear had been irretrievably lost due to my procrastination about seeing a doctor for my symptoms. I retain a very slight case of 'dry eye' but it is minor, doesn't require drops to alleviate and doesn't negatively impact my lifestyle. I consider myself truly blessed.
This neurosurgeon has now retired but my point here is that not all doctors reflexively recommend 'their' specialty (surgery or radiation). There are many members on these forums who have had a neurosurgeon or radiation oncologist recommend either approach, even if it wasn't their specialty. I suspect that doctors who routinely recommend only one approach probably believe it is best and have had good outcomes with surgery or radiation. That is why they are on the staff of an institution that focus on surgery or radiation. However, it can be confusing when respected doctors treating acoustic neuroma patients firmly contradict each other, sometimes to the point of being dismissive of an approach they do not specialize in. I would suggest that you seek out a doctor with lots of AN experience and when you find one - as I did - with experience, humility and a real concern for you rather than how soon they can schedule a procedure, hire that doctor.