A 70-year-old man had been experiencing slowly-progressive hearing loss in the right ear for 3 years. A brain MRI revealed an acoustic neuroma in the right cerebellopontine angle (CPA), Koos Grade III, with peritumoral edema and brainstem compression [Figure 1a]. Radiosurgical treatment with gamma-knife radiosurgery (GKR) was chosen because the patient refused surgery (PTV 8.85 cc, 12 Gy at 50%; PTV was equal to GTV; the procedure was frame-based with Gamma Knife Perfexion). Nine months later he started to complain of headache, nystagmus, and right limb ataxia with frequent falls. A brain MRI showed an extensive cerebellar PTBE with fourth ventricle compression and obstructive hydrocephalus [Figure 1b]. A ventriculoperitoneal shunt was performed; the surgical option was again ruled out due to the fear of brain swelling during surgery. Medical treatment with corticosteroids was protracted intermittently for 2 years; nevertheless, progressive neurological deterioration occurred and an MRI showed progressive cerebellar edema with unchanged tumor size. The severity of the neurological status warranted then the surgical removal of the schwannoma. No significant intraoperative cerebellar or brainstem swelling was reported. Histopathological examination confirmed a schwannoma (Grade I WHO). Few days after surgery, the patient developed severe sepsis caused by bowel perforation that was ascribed to the long use of corticosteroid together with the surgical stress. The patient died 2 weeks after surgery.