Epidemiology and naturalEpidemiology and naturalhistory of history of

vestibular schwannoma vestibular schwannoma

S-E.Stangerup, P.Caye-Thomasen, J.Thomsen, M.Tos S-E.Stangerup, P.Caye-Thomasen, J.Thomsen, M.Tos

ENT DepartmentENT Department

Gentofte University HospitalGentofte University Hospital

Copenhagen, DenmarkCopenhagen, Denmark

Subjects Subjects

• 2283 Diagnosed VS in the period; from 2283 Diagnosed VS in the period; from January 1976 to end December 2008.January 1976 to end December 2008.

• 1123 Operated after diagnosis 1123 Operated after diagnosis

• 16 Fractionated irradiation16 Fractionated irradiation

• 1144 Allocated to ”wait and scan”1144 Allocated to ”wait and scan”

Annual number of diagnosed vestibular Annual number of diagnosed vestibular schwannomas pr. million people in schwannomas pr. million people in

DenmarkDenmark

Mean tumour size at the time of diagnosisMean tumour size at the time of diagnosis

Mean age at the time of diagnosisMean age at the time of diagnosis

””Wait & scan” Subjects (1144) Wait & scan” Subjects (1144)

• MRI x 2 999

• Audiometry (PTA,Sd) x 2 932

• Localisation : Intrameatal 461

• Extrameatal 683

• Sex: female/male : 548/596

• Mean age: 58.6 years

AAO-HNS and WRS classification of hearing quality

0 30 50 100

30

50

A

B D

C

I II III

0 IV

Dl (%) Dl (%)

PTA(dB)

AAO-HNS WRS

0 30 50 100

Change in hearing during ”wait & scan”

I I

Diagnosis Last evaluation

61%

WRS classification

Loss of good hearing during observation, for patients with Loss of good hearing during observation, for patients with AAO class A and WRS class I hearing at diagnosis (n=932)AAO class A and WRS class I hearing at diagnosis (n=932)

Change in hearing during ”wait & scan”

I:

Dl<=30%

61%

WRS classification

Dl: 0%Dl: 1-10%Dl: 11-20%Dl:21-30%

33%24%26%17%

Loss of good hearing (Sd >= 70%) in the different prognostic groups

Loss of good hearing (Sd >= 70%) in the different prognostic groups

Loss of good hearing (Sd >= 70%) in the different prognostic groups

Loss of good hearing (Sd >= 70%) in the different prognostic groups

Mean annual speech discrimination loss in relation to Mean annual speech discrimination loss in relation to observation period before loosing WRS class 1 hearing observation period before loosing WRS class 1 hearing

0

10

20

30

40

50

60

1 2 3 4 5

Years of obs ervation before loos ing g ood hearing

% S

peec

h di

scri

min

ation

lo

ss

Tumor size at diagnosisTumor size at diagnosis<=15 mm 15-20 mm >20 mm <=15 mm 15-20 mm >20 mm

MRI after one year Op/irrad. OperationMRI after one year Op/irrad. Operation

No growth Growth (more than 2 mm)No growth Growth (more than 2 mm)

MRI after 2,3,4,5, Irradiation or operationMRI after 2,3,4,5, Irradiation or operation7,9 and 14 years 7,9 and 14 years

Treatment algoritm for VS patientsTreatment algoritm for VS patients