{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,27]],"date-time":"2026-09-27T08:20:02Z","timestamp":1790497202508,"version":"4.1.0"},"reference-count":38,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"3","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["PED"],"published-print":{"date-parts":[[2013,9]]},"abstract":"<jats:sec>\n                    <jats:title>Object<\/jats:title>\n                    <jats:p>In the face of increasing survival, quality of life (QOL) has become an important indicator of treatment success in children with posterior fossa brain tumors (PFBTs). The authors' objective was to assess the long-term QOL in survivors of PFBT.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>The authors conducted a cross-sectional study of children who, between birth and age 18 years at diagnosis, had previously been treated at their institution for a PFBT. At the time of assessment for this study, children were between 5 and 19 years old and had received standard treatment for PFBT ending at least 6 months before the assessment. The QOL was measured with the Pediatric Quality of Life Inventory (PedsQL) generic score scales and the Health Utilities Index Mark 3 (HUI3). Multivariate analyses were used to assess several variables (patient related, treatment related, and socioeconomic) for association with QOL.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>A total of 62 children participated in the study (median age at assessment 11.9 years, interquartile range [IQR] 7.8\u201314.8, and median age at tumor diagnosis of 4.9 years, IQR 2.5\u20136.9). Median time since active treatment for their PFBT was 5.2 years (IQR 2.4\u201310.1). Tumor types included cerebellar pilocytic astrocytoma (45.2%), medulloblastoma (30.6%), ependymoma (11.3%), and brainstem astrocytoma (11.3%). Adjuvant therapy included chemotherapy (40.3%) or radiotherapy (14.5% focal and 21.0% craniospinal radiotherapy). Permanent treatment for hydrocephalus was required in 38.7% of the patients. Tumors recurred in 11.3%, requiring repeat treatment in these patients. The median HUI3 utility score was 0.91 (IQR 0.71\u20131.00) and the median PedsQL total score was 78.3 (IQR 64.1\u201392.4). Only the following variables were significantly associated with decreased QOL in multivariable model testing (all p &lt; 0.05): need for permanent hydrocephalus treatment, large ventricle size, decreased family functioning, and lower family income.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>As a group, long-term survivors of pediatric PFBT appear to have QOL indicators that are similar to those of the general population, although a reasonable minority of patients experience poor outcomes. Although several confounding variables likely remain in this retrospective study, important associations with QOL include the presence of hydrocephalus and socioeconomic factors. The study sample size, however, was limited and the presence of other important factors cannot be excluded.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3171\/2013.6.peds12535","type":"journal-article","created":{"date-parts":[[2013,7,5]],"date-time":"2013-07-05T09:58:15Z","timestamp":1373018295000},"page":"235-240","source":"Crossref","is-referenced-by-count":61,"title":["Long-term quality of life in children treated for posterior fossa brain tumors"],"prefix":"10.3171","volume":"12","author":[{"given":"Abhaya V.","family":"Kulkarni","sequence":"first","affiliation":[{"name":"Divisions of Neurosurgery,"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Janine","family":"Piscione","sequence":"additional","affiliation":[{"name":"Rehabilitation, Hospital for Sick Children, University of Toronto, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Iffat","family":"Shams","sequence":"additional","affiliation":[{"name":"Divisions of Neurosurgery,"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eric","family":"Bouffet","sequence":"additional","affiliation":[{"name":"Oncology, and"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"key":"b1-peds12535","series-title":"Neurology","doi-asserted-by":"publisher","first-page":"1311","DOI":"10.1212\/01.WNL.0000120549.77188.36","article-title":"Long-term sequelae in children after cerebellar astrocytoma surgery","volume":"62","author":"Aarsen","year":"2004"},{"key":"b2-peds12535","series-title":"Br J Cancer","doi-asserted-by":"publisher","first-page":"255","DOI":"10.1054\/bjoc.1999.0912","article-title":"Cognitive and academic outcome following cranial irradiation and chemotherapy in children: a longitudinal study","volume":"82","author":"Anderson","year":"2000"},{"key":"b3-peds12535","series-title":"Qual Life Res","doi-asserted-by":"publisher","first-page":"249","DOI":"10.1007\/BF02260864","article-title":"Reliability of the Health Utilities Index\u2014Mark III used in the 1991 cycle 6 Canadian General Social Survey Health Questionnaire","volume":"4","author":"Boyle","year":"1995"},{"key":"b4-peds12535","series-title":"Fam Process","doi-asserted-by":"publisher","first-page":"97","DOI":"10.1111\/j.1545-5300.1988.00097.x","article-title":"Ontario Child Health Study: reliability and validity of the general functioning subscale of the McMaster Family Assessment Device","volume":"27","author":"Byles","year":"1988"},{"key":"b5-peds12535","series-title":"Am J Public Health","doi-asserted-by":"publisher","first-page":"702","DOI":"10.2105\/AJPH.2004.048124","article-title":"Understanding health disparities: the role of race and socioeconomic status in children's health","volume":"96","author":"Chen","year":"2006"},{"key":"b6-peds12535","series-title":"Neurosurgery","doi-asserted-by":"publisher","first-page":"638","DOI":"10.1227\/00006123-198711000-00006","article-title":"Factors affecting intellectual outcome in pediatric brain tumor patients","volume":"21","author":"Ellenberg","year":"1987"},{"key":"b7-peds12535","series-title":"Soc Sci Med","doi-asserted-by":"publisher","first-page":"799","DOI":"10.1016\/S0277-9536(03)00254-5","article-title":"Comparing directly measured standard gamble scores to HUI2 and HUI3 utility scores: group- and individual-level comparisons","volume":"58","author":"Feeny","year":"2004"},{"key":"b8-peds12535","series-title":"Arch Neurol","doi-asserted-by":"publisher","first-page":"818","DOI":"10.1001\/archneur.1992.00530320042010","article-title":"Cerebral white matter and cognition in hydrocephalic children","volume":"49","author":"Fletcher","year":"1992"},{"key":"b9-peds12535","series-title":"Childs Nerv Syst","doi-asserted-by":"publisher","first-page":"192","DOI":"10.1007\/BF00301250","article-title":"Morphometric evaluation of the hydrocephalic brain: relationships with cognitive development","volume":"12","author":"Fletcher","year":"1996"},{"key":"b10-peds12535","series-title":"Arch Neurol","doi-asserted-by":"publisher","first-page":"549","DOI":"10.1001\/archneur.1996.00550060093022","article-title":"Regional brain tissue composition in children with hydrocephalus. Relationships with cognitive development","volume":"53","author":"Fletcher","year":"1996"},{"key":"b11-peds12535","series-title":"Clin Psychol Rev","doi-asserted-by":"publisher","first-page":"547","DOI":"10.1016\/S0272-7358(01)00120-9","article-title":"Survivors of childhood brain tumors: behavioral, emotional, and social adjustment","volume":"22","author":"Fuemmeler","year":"2002"},{"key":"b12-peds12535","series-title":"Ann Med","doi-asserted-by":"publisher","first-page":"375","DOI":"10.3109\/07853890109002092","article-title":"The Health Utilities Index (HUI) system for assessing health-related quality of life in clinical studies","volume":"33","author":"Furlong","year":"2001"},{"key":"b13-peds12535","series-title":"J Clin Epidemiol","doi-asserted-by":"publisher","first-page":"327","DOI":"10.1016\/0895-4356(95)00528-5","article-title":"Reliability and validity of a comprehensive health status measure in a heterogeneous population of children admitted to intensive care","volume":"49","author":"Gemke","year":"1996"},{"key":"b14-peds12535","series-title":"Pediatr Blood Cancer","doi-asserted-by":"publisher","first-page":"452","DOI":"10.1002\/pbc.10469","article-title":"Measuring the neuro-cognitive side-effects of irradiation in children with brain tumors","volume":"42","author":"Grill","year":"2004"},{"key":"b15-peds12535","series-title":"Int J Radiat Oncol Biol Phys","doi-asserted-by":"publisher","first-page":"137","DOI":"10.1016\/S0360-3016(99)00177-7","article-title":"Long-term intellectual outcome in children with posterior fossa tumors according to radiation doses and volumes","volume":"45","author":"Grill","year":"1999"},{"key":"b16-peds12535","series-title":"Childs Nerv Syst","doi-asserted-by":"publisher","first-page":"117","DOI":"10.1007\/s00381-005-1231-4","article-title":"Functional outcome in young adults with spina bifida and hydrocephalus","volume":"22","author":"Hetherington","year":"2006"},{"key":"b17-peds12535","series-title":"Eval Rev","doi-asserted-by":"publisher","first-page":"631","DOI":"10.1177\/0193841X06291532","article-title":"Family factors in child care research","volume":"30","author":"Hungerford","year":"2006"},{"key":"b18-peds12535","series-title":"J Neurol Neurosurg Psychiatry","doi-asserted-by":"publisher","first-page":"591","DOI":"10.1136\/jnnp.67.5.591","article-title":"Link between the CSF shunt and achievement in adults with spina bifida","volume":"67","author":"Hunt","year":"1999"},{"key":"b19-peds12535","series-title":"Med Pediatr Oncol","doi-asserted-by":"publisher","first-page":"506","DOI":"10.1002\/(SICI)1096-911X(199812)31:6<506::AID-MPO7>3.0.CO;2-X","article-title":"Subsequent quality of life for children irradiated for a brain tumor before age four years","volume":"31","author":"Jenkin","year":"1998"},{"key":"b20-peds12535","series-title":"Int J Cancer Suppl","first-page":"106","article-title":"Comparison of screening instruments for disability and emotional\/behavioral disorders with a generic measure of health-related quality of life in survivors of childhood brain tumors","volume":"12","author":"Kennedy","year":"1999"},{"key":"b21-peds12535","series-title":"J Pediatr","doi-asserted-by":"publisher","first-page":"689","DOI":"10.1016\/j.jpeds.2008.04.068","article-title":"Medical, social, and economic factors associated with health-related quality of life in Canadian children with hydrocephalus","volume":"153","author":"Kulkarni","year":"2008"},{"key":"b22-peds12535","series-title":"Pediatr Neurosurg","doi-asserted-by":"publisher","first-page":"65","DOI":"10.1159\/000028836","article-title":"Measurement of ventricular size: reliability of the frontal and occipital horn ratio compared to subjective assessment","volume":"31","author":"Kulkarni","year":"1999"},{"issue":"5 Suppl","key":"b23-peds12535","series-title":"J Neurosurg","first-page":"358","article-title":"Quality of life in children with hydrocephalus: results from the Hospital for Sick Children, Toronto","volume":"107","author":"Kulkarni","year":"2007"},{"key":"b24-peds12535","series-title":"J Neurosurg","doi-asserted-by":"publisher","first-page":"1","DOI":"10.3171\/jns.1983.58.1.0001","article-title":"Quality of life in children treated for brain tumors. Intellectual, emotional, and academic function","volume":"58","author":"Kun","year":"1983"},{"key":"b25-peds12535","series-title":"J Marital Fam Ther","doi-asserted-by":"publisher","first-page":"345","DOI":"10.1111\/j.1752-0606.1985.tb00028.x","article-title":"The McMaster Family Assessment Device: reliability and validity","volume":"11","author":"Miller","year":"1985"},{"key":"b26-peds12535","series-title":"Int J Cancer Suppl","first-page":"91","article-title":"Correlation of the Health Utilities Index Mark 2 cognition scale and neuropsychological functioning among survivors of childhood medulloblastoma","volume":"12","author":"Mulhern","year":"1999"},{"key":"b27-peds12535","series-title":"Pediatr Neurosurg","doi-asserted-by":"publisher","first-page":"245","DOI":"10.1159\/000028730","article-title":"Frontal and occipital horn ratio: a linear estimate of ventricular size for multiple imaging modalities in pediatric hydrocephalus","volume":"29","author":"O'Hayon","year":"1998"},{"key":"b28-peds12535","series-title":"Pediatr Neurosci","doi-asserted-by":"publisher","first-page":"169","DOI":"10.1159\/000120325","article-title":"Quality of life in children with primitive neuroectodermal tumors (medulloblastoma) of the posterior fossa","volume":"13","author":"Packer","year":"1987"},{"key":"b29-peds12535","series-title":"J Neurosurg","doi-asserted-by":"publisher","first-page":"707","DOI":"10.3171\/jns.1989.70.5.0707","article-title":"A prospective study of cognitive function in children receiving whole-brain radiotherapy and chemotherapy: 2-year results","volume":"70","author":"Packer","year":"1989"},{"key":"b30-peds12535","series-title":"J Neurosurg Pediatr","doi-asserted-by":"publisher","first-page":"135","DOI":"10.3171\/2011.5.PEDS1178","article-title":"Multidisciplinary management of childhood brain tumors: a review of outcomes, recent advances, and challenges. 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