Venous sinus stenting versus ventriculoperitoneal shunting for idiopathic intracranial hypertension: propensity score weighted, cost consequence analysis

INTRODUCTION: Idiopathic intracranial hypertension (IIH) is characterized by elevated intracranial pressure, papilledema, and neurological symptoms. When medical management fails, treatment options include venous sinus stenting (VSS) and ventriculoperitoneal shunting (VPS). Comparative data on cost effectiveness remain limited. We aimed to compare clinical outcomes, healthcare utilization, and costs between VSS and VPS in patients with IIH using a propensity score weighted analysis. METHODS: This was a retrospective single center study. Baseline characteristics, complications, reoperations, unplanned 30 day emergency department visits and readmissions, unsatisfactory treatment response, salvage procedures, and inflation adjusted index procedure costs were collected. Propensity score weighting with overlap weights was applied to balance covariates. Weighted regression analyses were used to compare outcomes between groups. RESULTS: 139 patients were treated with VSS (n=99) or VPS (n=40). Baseline characteristics were well balanced after overlap weighting. Inflation adjusted index procedure costs and length of stay were similar between the VSS and VPS groups. VSS was associated with significantly lower rates of any complication (3.5% vs 37.7%, P<0.001), unplanned 30 day emergency department visits (11.1% vs 36.6%, P=0.002), 30 day readmissions (1.3% vs 33%, P<0.001), and reoperations, including revisions and surgically treated complications (1.3% vs 30.9%, P<0.001). There were no significant differences in unsatisfactory treatment response, need for salvage procedures, or overall subsequent procedures. CONCLUSIONS: While initial costs and clinical outcomes were similar, VPS was associated with higher complication rates, more revision related reoperations, and greater short term healthcare utilization. These findings suggest that VSS may provide a safer and more cost effective approach for patients with IIH who have failed medical therapy.