Background Treating medically refractory cases of idiopathic intracranial hypertension (IIH), CSF shunting is a common surgical technique. Lumboperitoneal shunting (LPS) is effective, but with a high revision rate. Frameless navigated ventriculoperitoneal shunt (VPS) is as effective as lumboperitoneal shunt but with less complication and revision rates.
Aim To assess efficacy and safety of frameless navigated ventriculoperitoneal shunt compared to lumboperitoneal shunt treating IIH. Predictors of shunting failure were evaluated.

Materials and Methods. Retrospective analysis of 62 patients with IIH treated by CSF shunting between January 2018 and March 2022. 32 patients had LPS and 30 patients had frameless navigated VPS. Demographics, clinical, ophthalmological, and radiological assessment were assessed. Clinical outcome, complications, shunt revision and predictors of shunt failure were evaluated.
Results 62 patients underwent CSF shunting for IIH. 32 patients had LPS and 30 had VPS with female predominance (22 in LPS and 26 in VPS). Most cases were in the childbearing period. Headache and visual affection were the most presentations in both groups. No statistical difference appeared as regards clinical outcome, but statistical difference favored VPS as regards complications and revision rates. BMI >35 and LPS were positive predictors of shunt failure on univariate analysis but BMI >35 was significant on multivariate analysis.
Conclusion Frameless navigated VPS and LPS achieve favorable clinical outcome in management of IIH. Frameless navigated VPS has less complications and revision rates. On univariate analysis, BMI>35 and LPS were significant on univariate analysis and only BMI>35 was significant on multivariate analysis predicting shunt failure.