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

Early revision after cerebrospinal fluid (CSF) diversion remains an important source of morbidity. We evaluated factors associated with 1-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 (PCD). The primary outcome was revision within 1 year. Kaplan-Meier analysis with log-rank testing evaluated revision-free survival. Logistic regression identified factors associated with 1-year revision.

Among 196 patients, 152 underwent de novo CSF diversion and 44 underwent revision of PCD. Overall, 32 patients (16%) underwent revision within 1 year. One-year revision occurred more frequently after revision of PCD 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 PCD (log-rank P<0.001). On univariate analysis, prior shunt status was associated with increased odds of revision (odds ratio [OR] 6.82, 95% confidence interval [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 1-year revision after permanent CSF diversion in adults and may identify patients who warrant closer surveillance and individualized counseling.