2026 Proffered Presentations
S199: EPIDEMIOLOGY OF VESTIBULAR SCHWANNOMAS: A CONTEMPORARY ANALYSIS FROM THE UNITED KINGDOM VESTIBULAR SCHWANNOMA REGISTRY.
Nathan Creber, PhD1; Shravan Gowrishankar1; Stephen O'Leary, PhD2; James Tysome, PhD1; Patrick Axon1; Colin Leonard3; Daniele Borsetto1; 1Cambridge University Hospitals NHS Trust, United Kingdom; 2The Royal Victorian Eye and Ear Hospital, Melbourne Australia; 3Royal Victoria Hospital, Belfast Heath and Social Care Trust, United Kingdom
Vestibular schwannomas are benign tumours arising from the Schwann cells of the vestibular nerve. Although benign, they can lead to significant morbidity due to the proximity to critical neurovascular structures, resulting in symptoms such as unilateral sensorineural hearing loss, tinnitus, imbalance, and, in advanced cases, brainstem compression. A rising incidence of sporadic vestibular schwannomas has been observed over time, with reports indicating a tenfold increase over the past 50 years. Initial population-based estimates report an incidence of approximately 10 to 15 vestibular schwannoma cases per million people per year, while more recent studies suggest incidences as high as 40 cases per million people per year. The rising incidence has largely been attributed to greater clinical awareness, increased use of screening for asymmetrical sensorineural hearing loss, and improved access to high-resolution intracranial MRI, which together have enhanced diagnostic rates. Large data set registrars are required for the accurate reporting of VS epidemiology, particularly in this new age of clinical awareness of readily available diagnostic tests.
METHODS: This cohort study utilised prospectively collected data from the British Skull Base Society National Vestibular Schwannoma Registry between 2012 and 2024. Adult patients, aged 18 years and older, who presented to a participating skull base centre with a diagnosis of vestibular schwannoma confirmed by imaging were included. Patients with a diagnosis of Neurofibromatosis Type 2 were excluded.
RESULTS: A total of 19,092 cases were recorded within the United Kingdom during the specified time period, calculated as an average incidence of approximately 25 cases per million people per year. The median age at diagnosis decreased gradually from 66 years in 2003 to 49 years in 2024. The proportion of patients diagnosed under the age of 50 increased over the study period. Larger tumour measurements at diagnosis were associated with a younger age, with approximately 25% of those aged less than 30 years presenting with an intracranial tumour dimension of greater than 30mm, compared to 12% in those aged 70 to 80 years. The risk of tumour growth decreased over time, with approximately 20% of tumours demonstrating growth of greater than 2 mm within the first 2 years after diagnosis, 35% within 5 years, and 48% within 10 years. Larger tumour size at presentation was more likely to be treated earlier after diagnosis, with 10% of intracanalicular tumours treated within the first 2 years, compared to 52% of tumours with an ICTD of >30mm during the same period.
DISCUSSION: This study presents an analysis of the largest national vestibular schwannoma registry to date. Contrary to previous reports, the mean age at diagnosis has decreased in recent years, possibly related to the availability and sensitivity of medical imaging. Consistent with previous studies, demonstrated tumour growth is more likely in the first 5 years from diagnosis, supporting the current surveillance schedules in a “watch wait and rescan” paradigm.