OBJECTIVE Idiopathic intracranial hypertension (IIH), or pseudotumor cerebri, is 
a complex and difficult-to-manage condition that can lead to permanent vision 
loss and refractory headaches if untreated. Traditional treatment options, such 
as unilateral ventriculoperitoneal (VP) or lumboperitoneal (LP) shunt placement, 
have high complication and failure rates and often require multiple revisions. 
The use of bilateral proximal catheters has been hypothesized as a method to 
improve shunt survival. The use of stereotactic technology has improved the 
accuracy of catheter placement and may improve treatment of IIH, with fewer 
complications and greater shunt patency time. METHODS The authors performed a 
retrospective chart review for all patients with IIH who underwent stereotactic 
placement of biventriculoperitoneal (BVP) shunt catheters from 2008 to 2016 at 
their institution. Bilateral proximal catheters were Y-connected to a Strata 
valve with a single distal catheter. We evaluated clinical, surgical, and 
ophthalmological variables and outcomes. RESULTS Most patients in this series of 
34 patients (mean age 34.4 ± 8.2 years, mean body mass index 38.7 ± 8.3 kg/m2; 
91.2% were women) undergoing 41 shunt procedures presented with headache (94.1%) 
and visual deficits (85.3%). The mean opening pressure was 39.6 ± 9.0 cm H2O. In 
addition, 50.0% had undergone previous unilateral shunt placement, and 20.6% had 
undergone prior optic nerve sheath fenestration. After BVP shunt placement, 
there were no cases of proximal catheter obstruction and only a single case of 
valve obstruction at 41.9 months, with a mean follow-up of 24.8 ± 20.0 months. 
Most patients showed improvement in their headache (82.4%), subjective vision 
(70.6%), and papilledema (61.5% preoperatively vs 20.0% postoperatively, p = 
0.02) at follow-up. Additional primary complications included 4 patients with 
migration of their distal catheters out of the peritoneum (twice in 1 patient), 
and an infection of the distal catheter after catheter dislodgment. The proximal 
obstructive shunt complication rate in this series (2.9%) was lower than that 
with LP (53.5%) or unilateral VP (37.8%) shunts seen in the literature. 
CONCLUSIONS This small series suggests that stereotactic placement of BVP shunt 
catheters appears to improve shunt survival rates and presenting symptoms in 
patients with IIH. Compared with unilateral VP or LP shunts, the use of BVP 
shunts may be a more effective and more functionally sustained method for the 
treatment of IIH.