Twenty-three elderly patients with acoustic neuroma have been followed conservatively (no treatment) for a mean of 3.8 years. Five patients subsequently required ventricular shunting. Two patients required partial excision of their tumors (one previously treated by shunting). Eleven patients who have required no treatment have no significant complaints. There was significant variation in tumor growth rates making predictability for surgical intervention hazardous. A mean growth rate of 0.22 cm/year was noted. Our statistics suggest tumor removal in healthy patients with larger tumors at time of presentation; in other patients, conservative follow-up may be more appropriate.