Recently, Maducdoc et al (2015) reported on 12 cases of “malignant transformation” from benign to malignant acoustic neuromas. Of note, some 42 percent of neurotologists treat acoustic neuroma with stereotactic radio surgery (SRS). Indeed, 8 of the 12 cases were noted following SRS and microsurgery (MS), while 4 of the 12 transformed after MS only. The authors note that the mechanism that may lead to a malignant transformation seems “more obvious” for SRS, and is less well understood for MS.