Koos Classification of Vestibular Schwannomas: A Reliability Study

Neurosurgery, Volume 85, Issue 3, September 2019, 409–414

The 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.

OBJECTIVE: To assess the intra- and inter-rater reliability of the Koos classification system.

METHODS: After 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).

RESULTS: Inter-rater reliability was found to be substantial when measured using Fleiss’ kappa (.71), extremely strong using Kendall’sW(.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.

CONCLUSION: We 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.