Patients presenting acutely due to hydrocephalus may be best treated with external ventricular drainage (EVD). This permits control over the amount of CSF drained, prevents peritoneal seeding with tumor (a rare event 1)), and may avoid having a permanent shunt placed in the significant number of patients who will not need one after tumor removal (although ≈ 90% of patients with a pineal germ cell tumor require a shunt). Ventricular access, via EVD or Frazier's point burr hole, in the post-op period is important in the event of acute hydrocephalus.