Visual deterioration in Idiopathic Intracranial Hypertension (IIH) warrants surgical intervention. All patients with IIH admitted to St. George’s, London for 10-years from 2010 were identified and those with shunts were analyzed retrospectively. Of 1234 IIH patients, 27 had shunts, 12/27 were aged 19-30 and 24 were females. The most common indication for a shunt was quantifiable visual impairment (52%). Majority had lumboperitoneal shunts (67%). The average length of stay was 16 days (2SD+/-8 days). In the first 3 years, neurologists were not involved in the care of 11/27 patients but all since. The number of shunts per year peaked at 6 in 2013 and is now 1-2. At first follow-up, vision and headache improved in 84% and 85% of patients, respectively. 40% had recurrence of symptoms despite a functioning shunt due to coexisting migraine (36%), functional neurological disorder (9%) or both (18%). The most common complication was shunt obstruction (single-revision; 30%; multiple-revisions; 19%), followed by low-pressure symptoms (26%), requiring readmissions in 81% of patients. Shunting is not without risks but is currently indicated in those with deteriorating visual function; hence, the decision to proceed with shunting in IIH should be made with vigilance in accordance with the 2018 consensus guidelines.