Surgical versus endovascular treatment for idiopathic intracranial hypertension

Idiopathic intracranial hypertension (IIH) is severe condition affecting patients' vision and quality of life. When medical treatment is insufficient, an invasive approach may be proposed, consisting of either performing a ventricular shunt or stenting a stenosed venous sinus. The aim of this study is to compare these two techniques.

All patients who received one of these treatments for IIH associated with papilledema over a 5-year period were analysed. The primary outcome was the resolution of papilledema at 3 months coupled with the absence of complications.

Over a 5-year period, 101 patients were analysed, of whom 61 underwent endovascular treatment and 40 underwent surgical treatment. Resolution of papilledema at three months without complications was achieved in 72% of cases in the surgical group and in 89% of cases in the endovascular group (p = 0.04). There was a higher proportion of IIH in the surgical group (60% vs 1.6%, p < 0.001) associated with higher intracranial pressure (38.8 vs 33.1 cmH₂O) and more severe visual impairment (55% vs 15%). Resolution of papilledema at three months, headache, tinnitus, and visual improvement did not differ significantly between the groups. The average time to improvement was significantly (p < 0.0001) shorter in the surgery-treated group (3.62 vs 8.74 weeks).

Endovascular treatment appears to have a better benefit-risk balance compared to surgery, with the caveat that the surgery group had a more severe presentation in this study. This encourages the conduction of a randomized study to have two homogeneous groups.