ObjectiveTo determine if an “observation” protocol with serial scanning is a safe and effective management paradigm for acoustic neuromas in the elderly.Study DesignA retrospective case review was performed.SettingThis study was performed in an academic, tertiary care center.PatientsForty-one patients over the age of 65 years were identified with the primary diagnosis of unilateral acoustic neuroma, without prior treatment or observation.InterventionThe patients were followed with serial, gadolinium-enhanced magnetic resonance imaging (MRI) scans performed at 6 months and then yearly, if no significant growth occurred.Main Outcome MeasuresThe patients were monitored for tumor growth, cranial nerve deficits, and hydrocephalus.ResultsThe patients were followed for an average of 3.5 years (range, 6 months to 9 years). The average tumor size at presentation was 1.14 cm, with a range of growth rates from 0 to 1.2 cm per year. Twenty-one patients demonstrated tumor growth at an average rate of 0.322 cm per year. Only five patients (12%) required further intervention. Three patients underwent translabyrinthine excision, and two patients were treated with radiation. No patients developed significant complications during the observation period.ConclusionsAcoustic neuromas in the older population can be managed safely using serial MRI scanning. No correlation could be made between initial tumor size and subsequent growth rate.