Objective : Hydrocephalus after intracerebral hemorrhage (ICH) is known to be related to poor prognosis and mortality. We analyzed predictors of permanent hydrocephalus in the patients with surgically treated supratentorial ICH.Methods : From 2004 to 2019, a total of 414 patients with surgically treated primary supratentorial ICH were included. We retrospectively analyzed age, sex, preexisting hypertension and diabetes, location and volume of ICH, presence and severity of intraventricular hemorrhage (IVH), and type of surgery.Results : Forty patients (9.7%) required shunt surgery. Concomitant IVH was higher in the ‘shunt required’ group (92.5%) than in the ‘shunt not required’ group (67.9%) (p=0.001). IVH severity was worse in the ‘shunt required’ group (13.5 vs. 7.5, p=0.008). Craniectomy (47.5%) was significantly high in the ‘shunt required’ group. According to multivariable analysis, the presence of an IVH was 8.1 times more frequent and craniectomy was 8.6 times more frequent in the ‘shunt required’ group. In the comparison between craniotomy and craniectomy group, the presence of an IVH was related with a 3.9 times higher (p=0.033) possibility and craniectomies rather than craniotomies with a 7-times higher possibility of shunt surgery (p<0.001). Within the craniectomy group, an increase in the craniectomy area by 1 cm2 was correlated with a 3.2% increase in the possibility of shunt surgery (odds ratio, 1.032; 95% confidence interval, 1.005-1.061; p=0.022).Conclusion : Presence of IVH, the severity of IVH and decompressive craniectomy were related to the development of shunt dependent hydrocephalus in the patients with ICH. The increasing size of craniectomy was related with increasing rate of shunt requirement.

Objective: A cavernous malformation (CM) is a type of an abnormally large collection of “low-flow” vascular channels without brain parenchyma intervening between the sinusoidal vessels; these occult lesions on transfemoral catheter angiograms were formerly known as “cryptic” vascular lesions. In this review, we briefly describe the overall characteristics of cerebral CMs and summarize radiosurgical methods and results of radiosurgery as treatment for CMs. Methods: The incidence, definition, and natural history of cerebral CMs are described. The principal issues of CMs are recurrent bleeding and seizures. These issues are compared to the radiosurgical interventions for CMs.Results: The rebleeding rates of CMs after radiosurgery is difficult to compare directly with untreated lesions because treated lesions are innately more vulnerable to rebleeding. Seizure outcomes after radiosurgery are also not easily estimated because of the various lesion locations; nevertheless, radiosurgery is an important treatment option for CMs in eloquent areas.Conclusion: Stereotactic radiosurgery (SRS) for CM has been effectively and widely used in recent years. Advances in magnetic resonance imaging and radiosurgery, as well as better studies of this condition’s natural history, are increasingly supporting the role of SRS as a complementary tool in CM treatment. More research is needed.