The purpose of this study is to determine if usage of early lumbar drainage leads to less shunt surgery and less catheter associated complications in patients with communicating hydrocephalus after intracerebral hemorrhage with severe ventricular involvement.

All patients requiring external ventricular drain (EVD) for treatment of acute obstructive hydrocephalus receive intraventricular fibrinolysis with rt-PA via the ventricular catheter. Lumbar drainage (LD) is inserted at a timepoint, when communication between the internal and the external CSF-spaces is recognizable on CT ("opening" of third and fourth ventricle and aqueduct).

Inclusion Criteria:

• supratentorial intracerebral hemorrhage <60ml
• intraventricular hemorrhage with casting of the third and fourth ventricles
• obstructive hydrocephalus with need of external ventricular drainage
• GCS <9 on admission or within 48h of symptom onset
• admission within 48h of symptom onset
• preceding modified Rankin scale ≤3
• age 18-85 years

Exclusion Criteria:

• ICH related to oral anticoagulation, trauma, tumor, arteriovenous malformation, aneurysm, systemic thrombolysis or sinus thrombosis
• infratentorial hemorrhage
• pregnancy
• admission 48h after symptom onset
• preceding modified Rankin scale >3