Abstract: Objective To report a pilot with acoustic neuroma who re-flied after gamma knife treatment and to establish the principles for its aviation medical identification. Methods Clinical diagnosis and treatment of a left acoustic neuroma, its follow-up data and the re-flight data about 1 pilot after gamma knife treatment were analyzed with the relevant literature reviewed. Results The size of acoustic neuroma was not significantly changed whereas the necrotic area was a little bit larger in the pilot 6 months after radiotherapy with no severe complications. Hypobaric chamber test showed that the functions of cochlea, vestibular system and brain were normal in the pilot. He was thus judged to be able to re-fly and received physical examination every 6 months. Conclusion The effect of gamma knife treatment is good on early unilateral acoustic neuroma in pilots. The pilots can re-fly if no severe complication occurs.