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Observation is usually considered the treatment of choice for two categories of patients:

• Older than 65 years
• Cannot medically tolerate undergoing surgery or stereotactic radiosurgery

If there are no serious symptoms present, some physicians may elect to carefully observe the tumor over a period of time until further symptoms develop. This may be the suggested course of treatment for people over the age of 65 when the physician weighs the growth rate of the tumor and possible complications against the patient's life expectancy. Since acoustic neuromas are slow growing tumors, some patients who are under the age of 65 may also elect watching and waiting as a management option.

The health care provider will typically order periodic MRIs to monitor the progress of the tumor during the watching and waiting period. If the tumor does not significantly increase in size, observation may be continued. In those cases where the tumor exhibits more rapid growth, interventional treatment is usually necessary.

Extended observation may also be considered for patients who have a tumor in their one hearing or "better hearing" ear when the removal of the tumor is likely to cause further or total hearing loss. In these cases, an extended period of observation serves to preserve the patient's ability to hear for as long as possible. When hearing is totally lost or the size of the tumor becomes life threatening other treatment options must be considered.

The decision to delay definitive treatment in favor of observation must be balanced by also considering:

• The potential for increased hearing loss if the tumor is not removed or prevented from growing
• Tumor progression may make treatment more difficult at a later point in time

Observation is a controversial issue regarding younger patients due to these two potential problems, especially because of the generally higher risk of complications for microsurgical resection of larger tumors.