Acta Neurochirurgica

, Volume 159, Issue 4, pp 733–738

Interobserver variability of the House-Brackmann facial nerve grading system for the analysis of a randomized multi-center phase III trial

  • Christian Scheller
  • Andreas Wienke
  • Marcos Tatagiba
  • Alireza Gharabaghi
  • Kristofer F. Ramina
  • Konstanze Scheller
  • Julian Prell
  • Johannes Zenk
  • Oliver Ganslandt
  • Barbara Bischoff
  • Cordula Matthies
  • Thomas Westermaier
  • Gregor Antoniadis
  • Maria Teresa Pedro
  • Veit Rohde
  • Kajetan von Eckardstein
  • Thomas Kretschmer
  • Malte Kornhuber
  • Fred G. BarkerII
  • Christian Strauss
Original Article - Brain Tumors

DOI: 10.1007/s00701-017-3109-0

Cite this article as:
Scheller, C., Wienke, A., Tatagiba, M. et al. Acta Neurochir (2017) 159: 733. doi:10.1007/s00701-017-3109-0

Abstract

Background

Evidence of a high interobserver variability of the subjective House-Brackmann facial nerve grading system (HBGS) would justify cost- and time-consuming technological enhancements of objective classifications for facial nerve paresis.

Method

A total of 112 patients were recruited for a randomized multi-center trial to investigate the efficacy of prophylactic nimodipine treatment in vestibular schwannoma (VS) surgery. For the present investigation both treatment groups were pooled for the assessment of facial nerve function preoperatively, in the early postoperative course and 1 year after the surgery. Facial nerve function was documented photographically at rest and in motion and classified according to the HBGS by three independent observers (neurosurgeon, neurologist, ENT) and by the investigator of each center.

Results

Interobserver variability was considerably different with respect to the three time points depending upon the severity of facial nerve paresis. Preoperative facial nerve function was normal or only mildly impaired (HB grade I or II) and was assessed consistently in 97%. Facial nerve function deteriorated during the early postoperative course and was subsequently documented without dissent in only 36%, with one grade difference in 45%, two grade difference in 17% and three grade difference in 2%. One year after surgery, facial nerve function predominantly improved resulting in a consistent assessment in 66%. Differing ratings were observed in 34% with one grade deviation in 88% and of two grades in 12%. Patients with differing ratings of two or more grades exhibited considerably worse facial nerve function (p < 0.001).

Conclusions

The HBGS produced comparable results between different observers in patients with normal or only mildly impaired facial nerve function. Interobserver variability increased depending on the severity of facial nerve paresis. The results suggest that the HBGS does not promote uniformity of reporting and comparison of outcomes in patients with moderate or severe facial nerve paresis.

Keywords

House-Brackmann Facial nerve Vestibular schwannoma Interobserver variability 

Copyright information

© Springer-Verlag Wien 2017

Authors and Affiliations

  • Christian Scheller
    • 1
  • Andreas Wienke
    • 2
  • Marcos Tatagiba
    • 3
  • Alireza Gharabaghi
    • 3
  • Kristofer F. Ramina
    • 3
  • Konstanze Scheller
    • 4
  • Julian Prell
    • 1
  • Johannes Zenk
    • 5
  • Oliver Ganslandt
    • 6
  • Barbara Bischoff
    • 6
  • Cordula Matthies
    • 7
  • Thomas Westermaier
    • 7
  • Gregor Antoniadis
    • 8
  • Maria Teresa Pedro
    • 8
  • Veit Rohde
    • 9
  • Kajetan von Eckardstein
    • 9
  • Thomas Kretschmer
    • 10
  • Malte Kornhuber
    • 11
  • Fred G. BarkerII
    • 12
  • Christian Strauss
    • 1
  1. 1.Department of NeurosurgeryMartin Luther University of Halle-WittenbergHalle (Saale)Germany
  2. 2.Institute of Medical Epidemiology, Biostatistics, and InformaticsUniversity of Halle-WittenbergHalle (Saale)Germany
  3. 3.Department of NeurosurgeryUniversity of TübingenTübingenGermany
  4. 4.Department of Oral and Maxillofacial Surgery and Facial Plastic SurgeryUniversity of Halle-WittenbergHalle (Saale)Germany
  5. 5.Department of Otorhinolaryngology, Head and Neck SurgeryUniversity of Erlangen-NurembergErlangenGermany
  6. 6.Department of NeurosurgeryUniversity of Erlangen-NurembergErlangenGermany
  7. 7.Department of NeurosurgeryWürzburg University HospitalWürzburgGermany
  8. 8.Department of Neurosurgery, Bezirkskrankenhaus GünzburgUniversity of UlmGünzburgGermany
  9. 9.Department of NeurosurgeryUniversity of GöttingenGöttingenGermany
  10. 10.Department of Neurosurgery, Evangelisches KrankenhausUniversity of OldenburgOldenburgGermany
  11. 11.Department of NeurologyUniversity of Halle-WittenbergHalle (Saale)Germany
  12. 12.Department of NeurosurgeryMassachusetts General HospitalBostonUSA