What question did this study set out to answer?

This research evaluates the effectiveness of venous sinus stenting compared to ventricular shunting in idiopathic intracranial hypertension, focusing on different patient phenotypes.

February 14, 2026

Comparative Effectiveness of Venous Sinus Stenting and Ventricular Shunting for Idiopathic Intracranial Hypertension: A Phenotype-Stratified, Propensity-Matched Cohort Study

Key Points

This research evaluates the effectiveness of venous sinus stenting compared to ventricular shunting in idiopathic intracranial hypertension, focusing on different patient phenotypes.
Identified adults with IIH who underwent VSS or VS using TriNetX database.
Stratified patients into four phenotypes based on obesity and visual symptoms.
Matched cohorts using propensity score to balance demographics and comorbidities.
Analyzed primary outcomes of headache, papilledema, and visual disturbance.
In the NO-NV phenotype, VS showed increased rates of headache and visual disturbances compared to VSS.
In the OV phenotype, VS was linked to higher rates of visual deficits.
In the ONV phenotype, VS associated with lower papilledema rates but higher headache rates.
Overall, shunted patients had higher retreatment rates and medical therapy needs compared to VSS patients.

Abstract

BACKGROUND AND OBJECTIVES: Venous sinus stenting (VSS) has emerged as an alternative treatment for selected idiopathic intracranial hypertension (IIH) cases, but its comparative effectiveness and safety vs ventricular shunting (VS) remain uncertain. Given the heterogeneity of IIH, we hypothesized that outcomes differ by patient phenotype defined by obesity and visual disturbance at diagnosis. METHODS: Adults with IIH who underwent VSS or VS shunting were identified using TriNetX. Patients were stratified into 4 prespecified phenotypes: nonobese-visual-disturbance (NO-V), nonobese-no-visual-disturbance (NO-NV), obese-visual-disturbance (OV), and obese-no-visual-disturbance (ONV). Within each phenotype, 1:1 propensity score matching balanced baseline demographics, comorbidities, and laboratory parameters. Primary outcomes were persistent headache, papilledema, and visual disturbance within 24 months. Secondary outcomes included retreatment, head computed tomography use, and emergency department visits. RESULTS: After matching (NO-V = 69, NO-NV = 186, OV = 305, ONV = 440 per arm), cohorts were well balanced. In NO-NV, VS was associated with higher rates of headache (risk difference RD: 0.11, P = .049), visual disturbances (RD: 0.11, P = .010), and emergency department visits (RD: 0.15, P = .006). NO-V showed no primary outcome differences, although vestibular disorders were more common with shunts (RD: 0.15, P = .008). In OV, VS shunting was linked to higher rates of visual deficits (RD: 0.11, P = .045). Conversely, in ONV, shunting was associated with lower rates of papilledema (RD: −0.6, P = .024) and pulsatile tinnitus (RD: −0.5, P = .004) but increased headaches (RD: 0.12, P < .001). Across phenotypes, shunted patients had greater head computed tomography use and retreatment rates, while VSS patients more often required ongoing medical therapy. CONCLUSION: The comparative effectiveness of VSS and VS in IIH varies by phenotype. VSS appears preferable in nonobese patients without visual symptoms, whereas VS may better control papilledema in obese patients without visual disturbance. Both treatments show similar efficacy in patients with baseline visual impairment. These findings underscore the need for phenotype-guided, prospective trials.

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Cite This Study

Maroufi et al. (Thu,) studied this question.

synapsesocial.com/papers/699011a12ccff479cfe58838 https://doi.org/https://doi.org/10.1227/neu.0000000000003957

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