Idiopathic Intracranial Hypertension Managed With Lumboperitoneal Shunting and Venous Sinus Stenting: A Report of Two Cases

Idiopathic intracranial hypertension (IIH) is a relatively rare disease of unknown pathogenesis initially managed by conservative medical treatment. For intractable cases, there is a trend toward endovascular venous sinus stenting (VSS) over traditional CSF diversion by surgical shunting. However, currently, there is no clear consensus regarding the selection of the surgical approach. We describe two cases of IIH in young women, each presenting with severe headache and visual disturbances, both resistant to initial medical therapy, and both found to have different patterns of transverse sinus stenosis. The first patient was a 33-year-old woman who underwent lumboperitoneal shunt surgery for treatment of venous stenosis suspected to be caused secondarily by extrinsic compression from raised intracranial pressure, while the second patient was a 23-year-old woman who was treated by endovascular sinus stenting for a suspected intrinsic form of venous stenosis. Each patient resulted in complete symptom resolution after two years of follow-up. Based on the findings and analysis of these two representative cases, distinguishing the form of venous sinus stenosis may be helpful in the selection of a surgical approach.