OBJECTIVE: The optimal management of medically refractory idiopathic intracranial hypertension (IIH) remains a point of debate. The senior author's practice evolved after a review of our units' practice in placing lumboperitoneal shunts revealed an unacceptably high rate of complication and revision. We now preferentially perform custom-designed electromagnetic (EM) image-guided ventriculoperitoneal shunt placement instead of lumboperitoneal shunting in treating medically refractory IIH and present our outcome data with this technique. PATIENTS AND METHODS: Retrospective case note review was carried out with prospective follow-up of 17 patients treated consecutively over a 3-year period. OUTCOME MEASURES: The article aims to assess the implication of using EM image-guided tracking technology in ventricular catheter placement in patients with IIH and to assess outcome. RESULTS: All of the patients improved clinically at the last follow-up compared to their preoperative condition. None of the patients experienced intra- or perioperative complications. All patients underwent ventriculoperitoneal shunt placement using EM guidance navigation. All patients in the EM subgroup were cannulated with a single pass, and satisfactory catheter placement was confirmed on a postoperative CT scan with concordant patient symptom improvement. CONCLUSION: Our series suggests that EM image-guided ventriculoperitoneal cerebrospinal fluid (CSF) shunting for IIH is a safe and effective procedure for ventricular cannulation and placement.