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

  • Original Article - Brain Tumors
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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.

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Acknowledgements

We thank Monika Göttlich, Jenny Hampel, Melanie Querfurt, Cornelia Seiffert and Christin Zöller, study nurses, for administrative contributions and assistance in performing this study.

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Authors and Affiliations

  1. Department of Neurosurgery, Martin Luther University of Halle-Wittenberg, Ernst-Grube-Str. 40, 06097, Halle (Saale), Germany

    Christian Scheller, Julian Prell & Christian Strauss

  2. Institute of Medical Epidemiology, Biostatistics, and Informatics, University of Halle-Wittenberg, Halle (Saale), Germany

    Andreas Wienke

  3. Department of Neurosurgery, University of Tübingen, Tübingen, Germany

    Marcos Tatagiba, Alireza Gharabaghi & Kristofer F. Ramina

  4. Department of Oral and Maxillofacial Surgery and Facial Plastic Surgery, University of Halle-Wittenberg, Halle (Saale), Germany

    Konstanze Scheller

  5. Department of Otorhinolaryngology, Head and Neck Surgery, University of Erlangen-Nuremberg, Erlangen, Germany

    Johannes Zenk

  6. Department of Neurosurgery, University of Erlangen-Nuremberg, Erlangen, Germany

    Oliver Ganslandt & Barbara Bischoff

  7. Department of Neurosurgery, Würzburg University Hospital, Würzburg, Germany

    Cordula Matthies & Thomas Westermaier

  8. Department of Neurosurgery, Bezirkskrankenhaus Günzburg, University of Ulm, Günzburg, Germany

    Gregor Antoniadis & Maria Teresa Pedro

  9. Department of Neurosurgery, University of Göttingen, Göttingen, Germany

    Veit Rohde & Kajetan von Eckardstein

  10. Department of Neurosurgery, Evangelisches Krankenhaus, University of Oldenburg, Oldenburg, Germany

    Thomas Kretschmer

  11. Department of Neurology, University of Halle-Wittenberg, Halle (Saale), Germany

    Malte Kornhuber

  12. Department of Neurosurgery, Massachusetts General Hospital, Boston, MA, USA

    Fred G. Barker II

Authors
  1. Christian Scheller
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  2. Andreas Wienke
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  3. Marcos Tatagiba
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  4. Alireza Gharabaghi
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  5. Kristofer F. Ramina
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  6. Konstanze Scheller
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  7. Julian Prell
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  8. Johannes Zenk
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  9. Oliver Ganslandt
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  10. Barbara Bischoff
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  11. Cordula Matthies
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  12. Thomas Westermaier
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  13. Gregor Antoniadis
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  14. Maria Teresa Pedro
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  15. Veit Rohde
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  16. Kajetan von Eckardstein
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  17. Thomas Kretschmer
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  18. Malte Kornhuber
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  19. Fred G. Barker II
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  20. Christian Strauss
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Corresponding author

Correspondence to Christian Scheller.

Ethics declarations

Registration and protocol

The multi-center study was registered before starting enrollment with the EudraCT number 2009-012088-32; KKSH-66; DRKS 00000328 and with the name "AkNiPro."

Funding

No funding was received for this research.

Conflict of interest

All authors certify that they have no affiliations with or involvement in any organization or entity with any financial interest (such as honoraria; educational grants; participation in speakers’ bureaus; membership, employment, consultancies, stock ownership, or other equity interest; and expert testimony or patent-licensing arrangements), or non-financial interest (such as personal or professional relationships, affiliations, knowledge or beliefs) in the subject matter or materials discussed in this manuscript.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.

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Scheller, C., Wienke, A., Tatagiba, M. et al. Interobserver variability of the House-Brackmann facial nerve grading system for the analysis of a randomized multi-center phase III trial. Acta Neurochir 159, 733–738 (2017). https://doi.org/10.1007/s00701-017-3109-0

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  • DOI: https://doi.org/10.1007/s00701-017-3109-0

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