• Nicholas J Erickson, Schmalz Philip G R PGR Department of Neurological Surgery, the University of Alabama at Birmingham, Birmingham, Alabama., Bonita S Agee, Matthew Fort, Beverly C Walters, Benjamin M McGrew, and Winfield S Fisher.
• Department of Neurological Surgery, the University of Alabama at Birmingham, Birmingham, Alabama.
• Neurosurgery. 2019 Sep 1; 85 (3): 409-414.

BackgroundThe Koos classification of vestibular schwannomas is designed to stratify tumors based on extrameatal extension and compression of the brainstem. While this classification system is widely reported in the literature, to date no study has assessed its reliability.ObjectiveTo assess the intra- and inter-rater reliability of the Koos classification system.MethodsAfter institutional review board approval was obtained, a cross-sectional group of the Magnetic Resonance imagings of 40 patients with vestibular schwannomas varying in size comprised the study sample. Four raters were selected to assign a Koos grade to 50 total scans. Inter- and intrarater reliability were calculated and reported using Fleiss' kappa, Kendall's W, and Intraclass correlation coefficient (ICC).ResultsInter-rater reliability was found to be substantial when measured using Fleiss' kappa (.71), extremely strong using Kendall's W (.92), and excellent as calculated by ICC (.88).Intrarater reliability was perfect for 3 out of 4 raters as assessed using weighted kappa, Kendall's W and ICC, with the intrarater agreement for the fourth rater measured as extremely high.ConclusionWe have demonstrated that the Koos classification system for vestibular schwannoma is a reliable method for tumor classification. This study lends further support to the results of current literature using Koos grading system. Further studies are required to evaluate its validity and utility in counseling patients with regard to outcomes.Copyright © 2018 by the Congress of Neurological Surgeons.

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