Stenting versus shunting in sight-threatening idiopathic intracranial hypertension: genuine equipoise

TL;DR

This paper discusses the ongoing debate between two surgical treatments for a dangerous eye condition caused by high intracranial pressure.

Contribution

The paper highlights the lack of randomized trials and the ongoing uncertainty in choosing between shunting and stenting for sight-threatening IIH.

Findings

Shunts have traditionally been the main surgical treatment for IIH.

Recent evidence suggests stenting may offer improved outcomes and fewer revision surgeries.

A UK-based randomized control trial is currently evaluating both interventions.

Abstract

This opinion piece discusses the challenges of managing a person with sight-threatening papilloedema due to idiopathic intracranial hypertension (IIH). With no available randomised controlled trials, clinicians often choose a locally available surgical intervention. An increasing number of studies have advocated using dural venous sinus stenting in IIH. Big data studies show that shunts have been the mainstay of surgical treatment for IIH, and recent evidence shows improved outcomes and fewer revision surgeries. There remains genuine equipoise in the choice of intervention between shunting and dural venous stenting in IIH. The IIH Intervention Trial funded by the National Institute of Health Research is underway in the UK, the first randomised control trial to evaluate both of these surgical interventions in people with sight-threatening IIH.

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