Christian Scheller1, Andreas Wienke2, Marcos Tatagiba3, Alireza Gharabaghi3, Kristofer F Ramina3, Konstanze Scheller4, Julian Prell5, Johannes Zenk6, Oliver Ganslandt7, Barbara Bischoff7, Cordula Matthies8, Thomas Westermaier8, Gregor Antoniadis9, Maria Teresa Pedro9, Veit Rohde10, Kajetan von Eckardstein10, Thomas Kretschmer11, Malte Kornhuber12, Fred G Barker13, Christian Strauss5. 1. Department of Neurosurgery, Martin Luther University of Halle-Wittenberg, Ernst-Grube-Str. 40, 06097, Halle (Saale), Germany. christian.scheller@uk-halle.de. 2. Institute of Medical Epidemiology, Biostatistics, and Informatics, University of Halle-Wittenberg, Halle (Saale), Germany. 3. Department of Neurosurgery, University of Tübingen, Tübingen, Germany. 4. Department of Oral and Maxillofacial Surgery and Facial Plastic Surgery, University of Halle-Wittenberg, Halle (Saale), Germany. 5. Department of Neurosurgery, Martin Luther University of Halle-Wittenberg, Ernst-Grube-Str. 40, 06097, Halle (Saale), Germany. 6. Department of Otorhinolaryngology, Head and Neck Surgery, University of Erlangen-Nuremberg, Erlangen, Germany. 7. Department of Neurosurgery, University of Erlangen-Nuremberg, Erlangen, Germany. 8. Department of Neurosurgery, Würzburg University Hospital, Würzburg, Germany. 9. Department of Neurosurgery, Bezirkskrankenhaus Günzburg, University of Ulm, Günzburg, Germany. 10. Department of Neurosurgery, University of Göttingen, Göttingen, Germany. 11. Department of Neurosurgery, Evangelisches Krankenhaus, University of Oldenburg, Oldenburg, Germany. 12. Department of Neurology, University of Halle-Wittenberg, Halle (Saale), Germany. 13. Department of Neurosurgery, Massachusetts General Hospital, Boston, MA, USA.
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.
RCT Entities:
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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