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Fiona C. Sampson, Andrew Hayward, Gillian Evans, Richard Morton and Beverly Collett

examine the effect of test doses of baclofen rather than to assess long-term benefits. A wide variety of different outcomes were described, but functional and QOL outcomes were generally not measured using standard scores. Studies often included heterogeneous patient groups (that is, individuals with different causes of spasticity), but results were reported for all patients together, making it difficult to assess whether the effectiveness of continuous intrathecal baclofen infusion was related to the underlying disease. In none of the identified studies were QOL

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Simone A. Betchen, Jane Walsh and Kalmon D. Post

, in which intracranial bone dust is present. They have found that the presence of bone dust and the use of intradural drilling increased headaches more than the absence of cranioplasty. 4, 10 Reducing bone dust and using cranioplasty may lower the incidence of headache and increase positive QOL outcomes. Women in our study scored lower in physical role limitations and physical functioning, similar to a study by Martin, et al., 16 in which women scored significantly lower in vitality, physical functioning, and pain. Looking at population normative data, the same

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Christian Foerch, Josef M. Lang, Jochen Krause, Andreas Raabe, Matthias Sitzer, Volker Seifert, Helmuth Steinmetz and Kirn R. Kessler

Object. Whether decompressive hemicraniectomy is an appropriate treatment for space-occupying middle cerebral artery (MCA) infarction is still a controversial issue. Previous studies are in agreement on a reduction of the mortality rate, but the reported functional outcome was highly variable. The authors sought to determine functional impairment, disability, and health-related quality of life (QOL) outcome in long-term survivors who had undergone this procedure, and tried to identify factors related to functional outcome.

Methods. The study included 36 consecutive patients (mean age 58.8 ± 12.7 years, 20 men and 16 women) who underwent decompressive hemicraniectomy for treatment of malignant MCA infarction (29 on the right and seven on the left side; mean time to surgery 37.8 ± 20 hours). The survival rate was determined at 6 months: 13.7 ± 6.7 months after the stroke, a cross-sectional personal investigation of survivors was performed to assess functional impairment, disability, and health-related QOL.

Survival rates were 78% at 6 months and 64% at the time of the follow-up investigation; one patient was lost to follow up. Sixteen of 22 long-term survivors lived at home. The median Barthel Index (BI) was 45 (25th and 75th percentile 19 and 71) and the BI correlated negatively with patient age (r = −0.58, p = 0.005). Three patients reached a BI of at least 90. Older age, more severe neurological deficit on admission, and longer duration of intensive care treatment and mechanical ventilation were significantly associated with worse disability (BI < 50). The health-related QOL was considerably impaired in the subscales of mobility, household management, and body care.

Conclusions. Decompressive hemicraniectomy improves survival in patients with malignant MCA infarction when compared with earlier reports of conservative treatment alone. Functional outcome and QOL remain markedly impaired, especially among elderly patients and in those with a severe neurological deficit at admission.

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Jeffrey W. Degen, Gregory J. Gagnon, Jean-Marc Voyadzis, Donald A. McRae, Michael Lunsden, Sonja Dieterich, Inge Molzahn and Fraser C. Henderson

Object. The authors conducted a study to assess safety, pain, and quality of life (QOL) outcomes following CyberKnife radiosurgical treatment of spinal tumors.

Methods. Data obtained in all patients with spinal tumors who underwent CyberKnife radiosurgery at Georgetown University Hospital between March 2002 and March 2003 were analyzed. Patients underwent examination, visual analog scale (VAS) pain assessment, and completed the 12-item Short Form Health Survey (SF-12) before treatment and at 1, 3, 6, 8, 12, 18, and 24 months following treatment.

Fifty-one patients with 72 lesions (58 metastatic and 14 primary) were treated. The mean follow-up period was 1 year. Pain was improved, with the mean VAS score decreasing significantly from 51.5 to 21.3 at 4 weeks (p < 0.001). This effect on pain was durable, with a mean score of 17.5 at 1 year, which was still significantly decreased (p = 0.002).

Quality of life was maintained throughout the study period. After 18 months, physical well-being was 33 (initial score 32; p = 0.96) and mental well-being was 43.8 (initial score 44.2; p = 0.97). (The mean SF-12 score is 50 ± 10 [standard deviation].) Adverse effects included self-limited dysphagia (three cases), diarrhea (two cases), lethargy (three cases), paresthesias (one case), and wound dehiscence (one case).

Conclusions. CyberKnife radiosurgery improves pain control and maintains QOL in patients treated for spinal tumors. Early adverse events are infrequent and minor. The authors await long-term follow-up data to determine late complications and tumor control rates.

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Claudius Thomé, Dimitris Zevgaridis, Olaf Leheta, Hansjörg Bäzner, Christiane Pöckler-Schöniger, Johannes Wöhrle and Peter Schmiedek

-up data confirms these results, bilateral laminotomy may prove advantageous for patients with lumbar stenosis, reducing the need for additional fusion surgery. Conclusions Bilateral and unilateral laminotomy allow adequate and safe decompression of the spinal canal in patients with lumbar stenosis. These limited decompression procedures resulted in a highly significant reduction of symptoms and disability and improve health-related QOL. Outcome after unilateral laminotomy is comparable with that after laminectomy. Bilateral laminotomy was associated with a

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Stephen A. Sands, Jessica S. Milner, Judith Goldberg, Vandana Mukhi, Jennifer A. Moliterno, Carol Maxfield and Jeffrey H. Wisoff

craniopharyngiomas to be affected by tumor recurrence, and the data in the present study further define how QOL can be expected to be affected for these patients, particularly measures of physical limitations from health problems being lower for patients requiring intervention for tumor recurrence. This study also expands on and confirms the findings of van Effentere and Boch 40 who reported normal neuropsychological status and good QOL outcomes for most of their cohort of adult and pediatric patients with craniopharyngiomas. It is important to point out, however, that van

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Quality of life assessment in patients undergoing nucleoplasty-based percutaneous discectomy

Invited submission from the Joint Section Meeting on Disorders of the Spine and Peripheral Nerves, March 2005

Peter C. Gerszten, William C. Welch and Joseph T. King Jr.

created at the 12-, 2-, 4-, 6-, 8-, and 10-o'clock positions. 57 The disc is entered from the symptomatic side where pain predominates. Forty-two patients (63%) underwent a bilateral approach to remove even more of the nucleus pulposus material or if the disc was centrally located. Outcome Instruments Clinical outcomes were assessed using a VAS for pain and two generic (that is, applicable to patients with various conditions and diseases) QOL outcomes instruments: the SF-36, and the EQ5D. Instruments were completed preoperatively, and at 3 and 6 months after

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Ken Y. Hsu, James F. Zucherman, Charles A. Hartjen, Thomas F. Mehalic, Dante A. Implicito, Michael J. Martin, Donald R. Johnson II, Grant A. Skidmore, Paul P. Vessa, James W. Dwyer, Joseph C. Cauthen and Richard M. Ozuna

surgery improves the QOL in patients with LSS. The present study was designed to compare the QOL outcomes in patients with LSS treated with a new device, the X STOP Interspinous Process Decompression System (St. Francis Medical Technologies, Inc., Driebergen, The Netherlands), with those obtained in patients who underwent nonoperative therapy. Nonoperative therapy was chosen as a control modality, both because it is a common treatment for mild to moderate neurogenic intermittent claudication and because implantation of the X STOP device, similar to nonoperative care

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Stéphanie Puget, Matthew Garnett, Alison Wray, Jacques Grill, Jean-Louis Habrand, Nathalie Bodaert, Michel Zerah, Mercia Bezerra, Dominique Renier, Alain Pierre-Kahn and Christian Sainte-Rose

, obsessive food-seeking behavior, and neuropsychological disorders) dramatically affect the outcome of children and their families. Few studies have been conducted to address these QOL outcomes or to modify the treatment of craniopharyngiomas accordingly. 10 , 16 , 25 Many authors have noted the need to individualize the treatment protocols to each child's presentation. 13 , 16 , 24 , 30 To this end, however, we have lacked both the appropriate classification systems and clinical indicators of outcome. Like many other pediatric services that for decades promoted radical

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Abhaya V. Kulkarni and Iffat Shams

, we used a very rigorous method with a validated QOL outcome measure 18 , 19 and independent verification of patient data. This allows us to comment with greater clarity on the true QOL of a typical population of children with long-standing hydrocephalus seen in the ambulatory care setting. In a recent editorial, Oakes 26 echoed the belief of many who live with hydrocephalus, in stating that health-care professionals need to pay more attention to the long-term social, emotional, as well as physical, outcomes. That was the ultimate intent of this current study