Neurocognitive Outcomes Following Venous Sinus Stenting versus Ventriculoperitoneal Shunting in Idiopathic Intracranial Hypertension

BACKGROUND: Idiopathic intracranial hypertension (IIH) is an increasingly common condition that predominantly affects young women. While medical treatments can prevent visual deterioration, many patients continue to suffer from other symptoms such as cognitive dysfunction and fatigue. Ventriculoperitoneal shunting (VPS) and venous sinus stenting (VSS) are treatment options for patients with refractory IIH; however, their comparative effectiveness on neurocognitive outcomes is unknown. METHOD: We have conducted retrospective cohort study using the 2016-2025 TriNetX US Collaborative Network compared VSS and VPS in patients with IIH treated within one year of diagnosis. Patients with baseline cognitive deficits or fatigue were excluded. Propensity score-matched cohorts (PSM, 1:1) were evaluated for new-onset neurocognitive changes and fatigue over five years using Kaplan-Meier analyses and Cox proportional hazards models. RESULTS: After PSM, 737 patients in each group were analyzed (mean age, 36.5 years; 91.5% female). Mean followup duration was 2.2 and 2.8 years for VSS and VPS patients, respectively. For neurocognitive deficits, VSS demonstrated lower event probabilities at all analyzed time points, culminating in 9.9% versus 19.1% at five years (p<0.001, HR 0.47 [95%CI 0.33-0.66]). For fatigue, VSS also showed lower event probabilities at all analyzed time points, culminating in 14.5% vs. 20.8% at five years (p=0.003, HR 0.63 [95%CI 0.46-0.85]). CONCLUSIONS: In this propensity score-matched retrospective cohort study of patients with IIH, VSS was associated with significantly lower risks of developing neurocognitive deficits and fatigue compared with VPS. These changes persisted beyond the perioperative period for up to five years.