Author(s): Joannides A.J.; Richards H.K.; Pickard J.D.; McMahon C.
Source: Fluids and Barriers of the CNS; 2018; vol. 15
Publication Date: 2018
Publication Type(s): Conference Abstract
Available at Fluids and Barriers of the CNS – from BioMed Central
Available at Fluids and Barriers of the CNS – from Europe PubMed Central – Open Access
Available at Fluids and Barriers of the CNS – from PubMed Central
Abstract:Introduction: CSF shunting has an important role in the management of refractory idiopathic intracranial hypertension (IIH). Shunt-related complications can be a source of significant morbidity arising from multiple revision procedures. On this background, we investigated the incidence and outcomes of shunting for patients with IIH within the UK population. Methods: Patients undergoing a CSF shunting procedure with a diagnosis of IIH recorded on the UK Shunt Registry between January 1995 and 31st December 2014 were included in the analysis. Patients with more than one underlying CSF disorder diagnosis were excluded. Analysis of time to revision was performed using the Kaplan-Meier method and statistical significance determined with the log-rank test. Results: A total of 2014 patients meeting the inclusion criteria were identified, undergoing 4042 procedures across 45 centres. The majority of patients were female (1692; 84%), and median age at surgery was 31 years [IQR 23-39 years]. The commonest reasons for shunt revision included underdrainage (54%), catheter migration (12%) and disconnection (9.2%). New shunt insertions accounted for 1776 of recorded procedures, including 788 ventricular shunts and 832 lumbar shunts. Median survival of new shunts was higher for ventricular as compared to lumbar shunts (736 weeks vs. 679 weeks; p = 0.005). Conclusions: Our data suggests that new shunts inserted for IIH are associated with a long time to first revision, with the commonest reasons for this relating to mechanical failure. Furthermore, ventricular shunts have a marginally longer period to first revision compared to lumbar shunts. Evaluation of other associated operative factors will be required to determine potential underlying reasons for the observed differences.