What question did this study set out to answer?

This analysis aims to compare the clinical outcomes and costs of venous sinus stenting versus ventriculoperitoneal shunting in idiopathic intracranial hypertension.

March 6, 2026

Venous sinus stenting versus ventriculoperitoneal shunting for idiopathic intracranial hypertension: propensity score weighted, cost consequence analysis

Key Points

This analysis aims to compare the clinical outcomes and costs of venous sinus stenting versus ventriculoperitoneal shunting in idiopathic intracranial hypertension.
Conducted a retrospective single-center study
Collected data on complications, reoperations, and emergency department visits
Applied propensity score weighting to balance baseline characteristics
Used weighted regression analyses to compare outcomes between VSS and VPS groups.
139 patients were treated with VSS (n=99) and VPS (n=40)
VSS showed lower complication rates (3.5% vs 37.7%, P<0.001)
VSS had fewer unplanned 30-day emergency visits (11.1% vs 36.6%, P=0.002) and readmissions (1.3% vs 33%, P<0.001)
Both approaches had similar initial costs and treatment responses.

Abstract

Introduction Idiopathic intracranial hypertension (IIH) is characterized by elevated intracranial pressure, papilledema, and neurological symptoms. When medical management fails, treatment options include venous sinus stenting (VSS) and ventriculoperitoneal shunting (VPS). Comparative data on cost effectiveness remain limited. We aimed to compare clinical outcomes, healthcare utilization, and costs between VSS and VPS in patients with IIH using a propensity score weighted analysis. Methods This was a retrospective single center study. Baseline characteristics, complications, reoperations, unplanned 30 day emergency department visits and readmissions, unsatisfactory treatment response, salvage procedures, and inflation adjusted index procedure costs were collected. Propensity score weighting with overlap weights was applied to balance covariates. Weighted regression analyses were used to compare outcomes between groups. Results 139 patients were treated with VSS (n=99) or VPS (n=40). Baseline characteristics were well balanced after overlap weighting. Inflation adjusted index procedure costs and length of stay were similar between the VSS and VPS groups. VSS was associated with significantly lower rates of any complication (3.5% vs 37.7%, P<0.001), unplanned 30 day emergency department visits (11.1% vs 36.6%, P=0.002), 30 day readmissions (1.3% vs 33%, P<0.001), and reoperations, including revisions and surgically treated complications (1.3% vs 30.9%, P<0.001). There were no significant differences in unsatisfactory treatment response, need for salvage procedures, or overall subsequent procedures. Conclusions While initial costs and clinical outcomes were similar, VPS was associated with higher complication rates, more revision related reoperations, and greater short term healthcare utilization. These findings suggest that VSS may provide a safer and more cost effective approach for patients with IIH who have failed medical therapy.

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