epidemiology and natural history of vestibular schwannoma
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Epidemiology and natural history of vestibular schwannoma. S-E.Stangerup , P.Caye-Thomasen , J.Thomsen , M.Tos ENT Department Gentofte University Hospital Copenhagen, Denmark. Subjects. 2283 Diagnosed VS in the period ; from January 1976 to end December 2008. - PowerPoint PPT PresentationTRANSCRIPT
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