Top down is the only possible choice. The game I'm currently playing in uses tokens (faces) instead of top down and it works fine, but I can't help but keep thinking how much better it would be if we went with top down especially given the relative realism of the maps. The fight for our lives that we are currently in would definitely benefit from top down as there are like 20 something combatants in a house - gang members, demons, sorcerers, and vampire slayers (that would be us).