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Updated: Feb 22, 2026
Neuronavigation and Laparoscopy Guided Ventriculoperitoneal Shunt Insertion for the Treatment of Hydrocephalus
Published on: October 14, 2022
Endovascular Venous Sinus Stenting versus CSF Shunting for Idiopathic Intracranial Hypertension: Nationwide
Huanwen Chen1, Marco Colasurdo2, Mihir Khunte3,4
1From the Department of Neurology (H.C.), MedStar Georgetown University Hospital, Washington DC.
Background And Purpose:
Endovascular venous sinus stent placement (VSS) is a promising new treatment for select patients with idiopathic intracranial hypertension (IIH) refractory to medical management. This study aims to investigate the safety and efficacy of VSS compared with neurosurgical CSF shunting in real-world clinical practice.
Materials And Methods:
This was a retrospective cohort study of the 2016-2022 Nationwide Readmissions Database in the United States. Adult patients who underwent elective IIH treatment with VSS or CSF shunting were identified. Propensity score matching (PSM) was performed to balance treatment groups. The primary outcome was IIH treatment failure, defined as hospital readmission for IIH-related symptoms, hardware complications, repeat surgery, or death within 300 days. Safety outcomes include morbidity and mortality, both periprocedurally and during follow-up. Rates of perioperative ischemic strokes, intracranial hemorrhage (ICH), and death were also assessed.
Results:
A total of 7795 patients were identified; 1511 (19.3%) underwent VSS. After PSM, 1370 VSS and 2786 CSF shunting patients remained. VSS was associated with a lower rate of treatment failure (hazard ratio [HR] 0.59 [95% CI, 0.43-0.80]; P < .001). The risk of morbidity/mortality was lower in the VSS group, both periprocedurally (2.2% versus 5.5%; P < .001) and throughout study follow-up (HR 0.38 [95% CI, 0.25-0.58]; P < .001). Rates of periprocedural ischemic stroke, ICH, and death were low for both cohorts (<1% for all).
Conclusions:
In this nationally representative study of real-world hospitalization data in the United States, endovascular VSS is associated with lower rates of treatment failure compared with conventional CSF shunting, as well as lower risk of morbidity and mortality. These findings provide real-world evidence that VSS is a safe and effective alternative to neurosurgical CSF shunting in select patients with IIH.
