Ventriculoperitoneal shunt versus transverse sinus stenting in idiopathic intracranial hypertension: A systematic review and meta-analysis.

Abstract

Introduction: Idiopathic intracranial hypertension (IIH) is characterized by elevated intracranial pressure with risk of visual impairment. Ventriculoperitoneal shunting (VPS) and transverse sinus stenting (TSS) are commonly used surgical options, but comparative evidence remains limited.

Methods: This systematic review and meta-analysis followed PRISMA guidelines and was registered in PROSPERO (CRD420251050247). PubMed, Web of Science, Cochrane CENTRAL, Embase, and Scopus were searched (2000-2025). Adult IIH patients treated with VPS or TSS were included. Random-effects meta-analysis was performed.

Results: Seventeen studies were included. Intracranial pressure reduction was significant following TSS (SMD -4.58; 95% CI: -5.72 to -3.44; p < 0.0001); however, no pooled VPS data were available, precluding direct comparison. Visual improvement occurred in 83.9% of patients, with no significant difference between TSS (84.1%) and VPS (83.3%) (p = 0.933). Headache improvement was observed in 73.6%, with no significant between-group difference (p = 0.628). Complication rates were low overall (0.1%), although the higher reported rate with TSS (1.56%) than VPS (approximately 0%) most likely reflects inconsistent complication definitions and incomplete event capture rather than a true procedural risk difference. Revision rates were lower with TSS (9.8%) than VPS (24.5%), but the difference was not statistically significant (p = 0.305).

Conclusion: VPS and TSS provide comparable clinical outcomes in IIH. TSS demonstrated numerically lower revision rates, although without statistical significance. These findings should be interpreted cautiously because the available evidence is derived predominantly from non-randomized, indirect comparisons with substantial indication bias, and the treatment groups likely differed systematically at baseline. Prospective phenotype-guided comparative studies are needed to better define the optimal surgical strategy.