Acoustic neuroma is the most common tumour in the cerebello-pontine angle.We present the results after surgery in 99 cases, and the natural course of the disease in 82 patients followed for up to 20 years (mean 3 years).During the observation period, 43% of the tumours increased in size. 36% of patients suffered increasing hearing loss. Total removal was accomplished in 92 cases. In 12 cases hearing preservation was attempted; successfully in five cases. 72 patients had normal or near normal postoperative facial nerve function, whereas 19 patients got a facial nerve paralysis. Two patients died, one because of haemorrhagic infarction and cerebellar swelling, and one because of ventricular fibrillation. Five patients had to be reoperated for CSF leakage.Acoustic neuroma treatment is still a challenge. We favour a team approach to treat this condition.