Outcome of Idiopathic Intracranial Hypertension: Papilledema Improvement Following Lumboperitoneal Shunt at Khyber Teaching Hospital

Background: Background: Idiopathic intracranial hypertension or pseudotumor cerebri is a clinical entity characterized by symptoms and signs of elevated intracranial pressure, cerebrospinal fluid opening pressure >25 cm H₂O, normal cerebrospinal fluid composition, and absence of radiological evidence of causative lesions on magnetic resonance imaging or computed tomography. Treatment options vary from conservative to surgical. The use of Lumboperitoneal Shunt has been well documented as treatment modality for patient with idiopathic intracranial hypertension. Objective: To evaluate the outcome of idiopathic intracranial hypertension in terms of improvement in papilledema following lumboperitoneal shunt placement and to analyze predictive factors for treatment success. Methodology: This cross-sectional descriptive study was conducted at Khyber Teaching hospital Peshawar from June 2023 to June 2025 among 32 patients. Study design was non-probability purposive. Informed consent was obtained from all patients. Female patients with age range from 18 to 45 years with diagnosed cases of IIH were included. Statistical analysis included chi-square tests, paired t-tests, Fisher's exact test, and correlation analysis using SPSS version 28. Results: Among 32 female participants (mean age: 32.8±2.1 years), pre-surgical fundoscopic examination revealed grade 1 papilledema in 18 cases (56.2%) and grade 2 in 14 cases (43.8%). Mean cerebrospinal fluid opening pressure measured 38.2±4.5 cm H₂O (range: 28-48). Following lumboperitoneal shunt insertion, optic disc swelling resolved in 29 patients (90.6%), while cephalgia subsided in 26 cases (81.3%). Surgical intervention within six months of symptom onset demonstrated superior therapeutic efficacy compared to delayed procedures (100% vs 76.9% papilledema resolution; OR=4.44,95% CI [1.12-17.62], p=0.032). Post-surgical CSF pressure reduction proved statistically robust (mean decrease: 20.7±5.4 cm H₂O; t=21.760, p<0.001). Conclusion: Lumboperitoneal shunt demonstrates excellent efficacy for papilledema improvement in IIH with 90.6% success rate. Early intervention before advanced papilledema develops is crucial for optimal outcomes. The procedure has acceptable complication rates and should be considered in medically refractory cases.