Visual and headache outcomes following lumboperitoneal shunting in idiopathic intracranial hypertension: a prospective observational study

BACKGROUND: Idiopathic intracranial hypertension (IIH) threatens vision and quality of life, with lumboperitoneal shunting (LPS) often used when medical therapy fails. However, prospective evidence on visual and headache outcomes remains limited. METHODS: In this prospective observational study (Jan 2024–Jun 2025), 31 IIH patients underwent primary LPS at a tertiary neurosurgical center. Primary outcomes were visual improvement (≥ 2 Snellen lines) and headache relief (≥ 3-point reduction on Visual Analog Scale [VAS]) at six months. Secondary outcomes included papilledema regression and complications. RESULTS: The cohort included 28 women (90.3%) and 3 men (9.7%), mean age 35.3 years, mean BMI 35.4 kg/m². At six months, 27 patients (87.1%) reported headache relief (median VAS 8.0→3.3, p < 0.001). Objective visual improvement occurred in 25 patients (80.6%), while papilledema demonstrated statistically significant regression as measured by the modified Frisén scale with Frisén grade reducing from median 4 to 2 (p < 0.001). Complications developed in 6 patients (19.4%), most commonly infection (12.9%). CONCLUSION: LPS was associated with significant short-term improvement in headache severity, visual function, and papilledema in patients with IIH. Larger multicenter trials are warranted to define long-term outcomes and comparative effectiveness.