Independent Predictors of Early Revision Following Permanent Cerebrospinal Fluid Diversion in Adults.

Abstract

Early revision after cerebrospinal fluid (CSF) diversion remains an important source of morbidity. We evaluated factors associated with one-year revision after permanent CSF diversion in adults, with emphasis on prior shunt history. We performed a retrospective cohort study of adult patients undergoing permanent CSF diversion at a single tertiary care institution. Patients were categorized as de novo or revision of prior CSF diversion. The primary outcome was revision within one year. Kaplan-Meier analysis with log-rank testing evaluated revision-free survival. Logistic regression identified factors associated with one-year revision. Among 196 patients, 152 underwent de novo CSF diversion and 44 underwent revision of prior CSF diversion. Overall, 32 patients (16%) underwent revision within 1 year. One-year revision occurred more frequently after revision of prior CSF diversion than after de novo diversion (18/44, 41% vs. 14/152, 9.2%; p < 0.001). Kaplan-Meier analysis demonstrated significantly lower revision-free survival among patients undergoing revision of prior CSF diversion (log-rank p < 0.001). On univariate analysis, prior shunt status was associated with increased odds of revision (OR 6.82, 95% CI 3.02-15.41; p < 0.001). In multivariable analysis adjusting for age and idiopathic intracranial hypertension (IIH), prior shunt status remained independently associated with revision (adjusted OR 3.57, 95% CI 1.44-8.83; p = 0.006), as did IIH (adjusted OR 3.26, 95% CI 1.19-8.91; p = 0.022). Prior shunt history and IIH were independently associated with one-year revision after permanent CSF diversion in adults and may identify patients who warrant closer surveillance and individualized counseling.