1. Epidemiology and natural history of vestibular schwannoma
S-E.Stangerup, P.Caye-Thomasen, J.Thomsen, M.Tos
ENT Department
Gentofte University Hospital
Copenhagen, Denmark
Mr. Chairman, dear collegues.
During the past 15 years there have been several reports on increasing incidense of VS. If this increase in the number of diagnosed VS reflects a tru increase in incidence or if we because of easier access to MRI scans finds the ones that should have been diagnosed earlier we really do not know. Only time will show this.
The aim of our study is to describe and analyze this phenominom.

2. Subjects
2283 Diagnosed VS in the period; from January 1976 to end December 2008.
1123 Operated after diagnosis
16 Fractionated irradiation
1144 Allocated to ”wait and scan”
In Denmark with a population of aproximately 5.2 Mil.all treatment of VS is centralyzed in the ENT Dept. In one center (Gentofte University Hospital).
During the period…….

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

4. Mean tumour size at the time of diagnosis

5. Mean age at the time of diagnosis

6. ”Wait & scan” Subjects (1144)
MRI x
Audiometry (PTA,Sd) x
Localisation : Intrameatal
Extrameatal
Sex: female/male : /596
Mean age: years

7. AAO-HNS and WRS classification of hearing quality
Dl (%) Dl (%) A B D C
I II III IV 30 50
PTA
(dB)
AAO-HNS WRS

8. Change in hearing during ”wait & scan”
WRS classification
Diagnosis Last evaluation I I
61%

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

10. Change in hearing during ”wait & scan”
WRS classification I:
Dl<=30%
Dl: %
Dl: %
Dl: 11-20%
Dl:21-30%
33%
24%
26%
17%
61%

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

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

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

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

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

16. Treatment algoritm for VS patients
Tumor size at diagnosis
<=15 mm mm >20 mm
MRI after one year Op/irrad Operation
No growth Growth (more than 2 mm)
MRI after 2,3,4,5, Irradiation or operation
7,9 and 14 years