Surgical outcomes in pediatric idiopathic intracranial hypertension: a systematic review and meta-analysis of CSF shunting, optic nerve sheath fenestration, and venous sinus stenting

Symptom and ophthalmological improvement were similar across surgical modalities in pediatric patients with IIH with vision-threatening papilledema. ONSF offers high visual acuity preservation with low reintervention rates, making it well suited for urgent vision preservation. CSF shunt placement provides global intracranial pressure control that alleviates associated symptoms, but it is associated with frequent revisions. VSS is effective for patients with venous sinus stenosis and a pressure gradient and thus requires these important prerequisites before stent placement. Larger, pediatric-specific comparative studies are needed to optimize surgical decision-making.