Vestibular schwannoma (VS) is a benign tumor which tends to grow slowly. In general, the growth rate of VS is about 1mm/year. We treated an unusual case of rapid growing VS associated with multiple cystic changes. Also, we review the natural history and factors influencing tumor growth of VS. A 75-year old female patient presented with gait disturbance and hearing loss. Brain magnetic resonance imaging (MRI) showed a mass of 4.0×4.0×3.5cm size with multiple cystic changes and heterogeneous enhancement in right cerebellopontine angle (CPA). Twelve six months ago, the patient had a brain MRI which revealed CPA mass less than 1.0cm in diameter. Small sized VSs should be followed up with MRI at least every two years and the VSs consisted with cystic component need to be more closed observation than the solid type.
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