Early Lumbar Drainage for Intraventricular Hemorrhage

Inclusion Criteria: * Aged 18 to 85 years old, no limitation on gender. * First-ever intracerebral hemorrhage confirmed by CT/MRI, accompanied by third and/or fourth intraventricular hemorrhage, requiring external ventricular drainage. * Baseline hemorrhage volume less than 30 mL, with stable clinical condition before randomization. * External ventricular drainage performed within 48 hours of symptom onset. * Randomization completed within 24 hours after EVD placement. * Pre-morbid modified Rankin Scale (mRS) score of 0 or 1. * Written informed consent obtained from the participant or their legally authorized representative. Exclusion Criteria: * Suspected or untreated ruptured intracranial aneurysm, arteriovenous malformation (AVM), or intracranial tumor, unless excluded by vascular imaging. Previously treated aneurysm or AVM must have been completed at least 3 months prior to enrollment. * Choroidal vascular malformation or moyamoya disease. • Long-term oral anticoagulant use, persistent coagulation dysfunction, or known allergy to urokinase. * Platelet count \< 100×10⁹/L or INR \> 1.4. * Absolute contraindications to lumbar cistern drainage or external ventricular drainage, such as cerebral hernia or infection at the puncture site. * Infratentorial hemorrhage volume ≥ 10 mL. * Thalamic hemorrhage ≥ 10 mL, or accompanied by midbrain extension, oculomotor nerve palsy, or fixed dilated pupil. * Hemiplegia with muscle strength grade 0 or 1. * Active bleeding in the gastr…