Prospective Randomized, Controlled Trial for Treatment of Intraventricular Hemorrhage

Inclusion Criteria: * Age 18-75 * Radiographic evidence of intraventricular hemorrhage with hydrocephalus * Admission Glasgow Coma Scale ≥ 5 (motor score ≥ 2) * Placement of an external ventricular drain with an opening pressure \>20 mm Hg Exclusion Criteria: * Intraventricular hemorrhage secondary to cerebral aneurysm, arteriovenous malformation, or tumor * Coagulopathy (Platelet count \<100,000, International normalized ratio \>1.5. Reversal of warfarin is permitted.) * Age \<18 or \>75 * Pregnancy (positive pregnancy test) * Clotting disorders * Medical contraindications to administration of general anesthesia as determined by the attending anesthesiologist * Medical contraindications to surgery as determined by the attending neurosurgeon * Contraindication to recombinant tissue plasminogen activator administration: * Evidence of enlargening intracranial hemorrhage as evidenced by an increase in intracranial hemorrhage volume (\>5 ml) on CT obtained after EVD placement * Internal bleeding, involving retroperitoneal sites, or the gastrointestinal, genitourinary, or respiratory tracts * Superficial or surface bleeding, observed at vascular puncture and access sites (e.g. venous cutdowns, arterial punctures) or site of recent surgical intervention * Evidence of cerebrospinal infection by Gram stain or culture * Advanced directive indicating Do Not Resuscitate or Do Not Intubate status