Related Experiment Video

Updated: May 14, 2026

Neuronavigation and Laparoscopy Guided Ventriculoperitoneal Shunt Insertion for the Treatment of Hydrocephalus
14:59

Neuronavigation and Laparoscopy Guided Ventriculoperitoneal Shunt Insertion for the Treatment of Hydrocephalus

Published on: October 14, 2022

Neurocognitive Outcomes Following Venous Sinus Stenting versus Ventriculoperitoneal Shunting in Idiopathic

Huanwen Alvin Chen1, Dhairya A Lakhani1, Marco Colasurdo1

  • 1From the Department of Neurosurgery, University of Maryland Medical Center, Baltimore MD; Department of Neurology, University of Maryland Medical Center, Baltimore MD; Department of Neuroradiology, Rockefeller Neuroscience Institute, West Virginia University, Morgantown, WV; Department of Neurological Surgery, Oregon Health and Science University, Portland OR; Department of Neurological Surgery, Oregon Health and Science University, Portland OR; Departmet of Neurology, Edward Via college of osteopathic medicine, Blacksburg, VA; Department of Radiology, Yale New Haven hospital, New Haven, CT; and Department of Diagnostic Radiology, Medical Research Center (MRC), Oulu University Hospital, Oulu, Finland.

AJNR. American Journal of Neuroradiology
|May 12, 2026
PubMed

Insights

Venous sinus stenting (VSS) shows better outcomes than ventriculoperitoneal shunting (VPS) for treating idiopathic intracranial hypertension (IIH). VSS significantly reduces the risk of neurocognitive deficits and fatigue in IIH patients compared to VPS.

Area of Science:

  • Neurology
  • Neurosurgery
  • Ophthalmology

Background:

  • Idiopathic intracranial hypertension (IIH) predominantly affects young women and can cause debilitating symptoms beyond vision loss, including cognitive dysfunction and fatigue.
  • Current medical treatments for IIH primarily focus on preventing vision loss, leaving a significant unmet need for managing other persistent symptoms.
  • Ventriculoperitoneal shunting (VPS) and venous sinus stenting (VSS) are invasive options for refractory IIH, but their comparative effectiveness on neurocognitive and fatigue outcomes remains unclear.

Purpose of the Study:

  • To compare the effectiveness of venous sinus stenting (VSS) versus ventriculoperitoneal shunting (VPS) in patients with idiopathic intracranial hypertension (IIH).
  • To evaluate the long-term impact of VSS and VPS on neurocognitive outcomes and fatigue in IIH patients.
  • To identify potential differences in the risk of developing new-onset neurocognitive deficits and fatigue between VSS and VPS treatment groups.

Main Methods:

  • A retrospective cohort study was conducted using the TriNetX US Collaborative Network (2016-2025).
  • Propensity score-matched (PSM) cohorts (1:1 ratio) of IIH patients treated with VSS or VPS within one year of diagnosis were analyzed.
  • Exclusion criteria included baseline cognitive deficits or fatigue; outcomes assessed over five years included new-onset neurocognitive changes and fatigue using Kaplan-Meier analyses and Cox proportional hazards models.

Main Results:

  • After PSM, 737 patients were analyzed in each group (mean age 36.5 years, 91.5% female).
  • VSS demonstrated significantly lower event probabilities for neurocognitive deficits compared to VPS at five years (9.9% vs. 19.1%, p<0.001, HR 0.47).
  • VSS also showed significantly lower event probabilities for fatigue compared to VPS at five years (14.5% vs. 20.8%, p=0.003, HR 0.63).

Conclusions:

  • Venous sinus stenting (VSS) is associated with a significantly lower risk of developing neurocognitive deficits and fatigue in idiopathic intracranial hypertension (IIH) patients compared to ventriculoperitoneal shunting (VPS).
  • These beneficial effects of VSS on neurocognitive function and fatigue persist for up to five years post-procedure.
  • The findings suggest VSS may be a preferred treatment option for refractory IIH when considering the broader spectrum of patient symptoms beyond visual impairment.
Abstract

Related Concept Videos

Increased Intracranial Pressure l: Introduction01:14

Increased Intracranial Pressure l: Introduction

Intracranial hypertension is a sustained elevation of intracranial pressure (ICP) above 22 mm Hg. In supine adults, normal ICP is ~7–15 mm Hg.The rigid, nonexpandable cranium contains three components—brain tissue, blood, and cerebrospinal fluid (CSF)—that total ~1,700 mL in a typical adult: 1,400 mL brain (~80%), 150 mL blood (~10%), and 150 mL CSF (~10%). According to the Monro–Kellie doctrine, total intracranial volume is effectively fixed. When one component expands, CSF and venous blood...
Increased Intracranial Pressure ll: Pathophysiology01:29

Increased Intracranial Pressure ll: Pathophysiology

Increased intracranial pressure (ICP) refers to a potentially life-threatening rise in pressure inside the skull. This usually happens when there is a major change in the volume of brain tissue, blood, or cerebrospinal fluid (CSF) — the three components inside the skull. According to the Monro-Kellie doctrine, if the volume of one component increases, the volumes of the other components must decrease to maintain normal pressure. If this does not happen, ICP rises.The process often begins with...
Cerebral Edema ll: Pathophysiology01:22

Cerebral Edema ll: Pathophysiology

Vasogenic edema is a major form of cerebral edema characterized by abnormal accumulation of fluid in the brain’s extracellular space due to disruption of the blood–brain barrier (BBB). The BBB is a specialized structure composed of endothelial cells connected by tight junctions, supported by astrocytic endfeet and a basement membrane. Under normal conditions, it tightly regulates the movement of ions, proteins, and solutes between the bloodstream and brain parenchyma. When this barrier loses...