Background: There is an absence of studies evaluating longitudinal quality of life (QoL) amongst vestibular schwannomas (VS) with matched tumor and patient characteristics between treatment groups. We present novel findings of 12 yearlong follow-up of patient QoL and symptomatology outcomes in this matched cohort study. Methods: Symptomatology and 36-Item Short Form Health Survey (SF36) between 2000-2017 in VS patients managed at a single tertiary centre was conducted. Radiation (R) and active surveillance (A) groups were matched for tumor size and age against the surgery (S) group. Results: 14 A patients, 24 R patients, 49 S patients met matching and inclusion criteria. Mean age, tumor diameter and follow up was 69.1 years, 21.6mm and 12.0 years respectively. Mental component summary (MCS) scores deteriorated significantly in the radiation group (3.1 S, 3.7 A, -3.5 R, p-value 0.008). Physical component summary scores remained stable at follow up (-0.2 S, 0.00 S, -4.0 R, p-value 0.227). Various symptoms resolved statistically in surgery goup, whereas tinnitus on follow up was higher with radiation (40.8% S, 66.7% R, p-value 0.038). Conclusions: Surgery group demonstrated improvements in long term QoL with good symptom resolution, whilst radiation group demonstrated small but significant deterioration over time.