Background: Idiopathic intracranial hypertension (IIH) is a unique disorder that is characterized by an intractable high intracranial pressure. Several interventions have been in clinical practice upon failure of medical management. Yet, none of the available modalities have been evaluated systematically for an CSF diverion procedure. Methods: We conducted a systematic review in order to compare the therapeutic efficacy of the most two common interventions, namely VPS vs. LPS. The complications rate and incidence of shunt revision were assessed. The electronic database from EMBASE, Medline, Cochrane databases, and references of review articles have been used. Results: A total of five retrospective comparative studies had been included out of 724 articles based on inclusion and exclusion criteria. A 2570 VPS were compared to 1832 LPS with 85% of heterogeneity. Although there was a tendency that suggests better outcome in VPS over LPS but it was not statistically significant [OR=0.91, 95% CI: 0.26-3.24]. Similar tendency was observed as well with shunt obstruction. Conclusions: The overall outcomes for stabilizing visual deterioration and improvement of headaches were similar among VPS and LPS. A large prospective multicenteric randomized controlled trial is needed in order to compare effectiveness of VPS and LPS, and also to establish a treatment guideline for IIH.