A 75-year-old woman presented with a small right vestibular schwannoma which enlarged and then spontaneously regressed during conservative management. The tumor increased in size from 5.2 to 16.7 mm over 7 years with worsening symptoms of tinnitus, dizziness, and headache. The tumor then regressed to 8.2 mm and the symptoms improved for 4 years without further treatment. Changes in tumor growth should be carefully monitored during conservative management of patients with vestibular schwannoma.