Patients with brain metastases and concurrent hydrocephalus warrant expedited treatment. This study evaluated survival outcomes of patients with brain metastases and hydrocephalus treated with endoscopic third ventriculostomy (ETV) or ventriculoperitoneal shunt (VPS) placement. Materials and methods: Twenty patients with brain metastases and hydrocephalus were treated with ETV or VPS over 10 years (July 18, 2013-November 20, 2023). Our findings were juxtaposed against data from 77 published controls to assess whether ETV and VPS management correlated with enhanced survival. Results: The most common primary cancer diagnoses were breast (9 [45%]) and non-small cell lung cancer (5 [25%]). Seven (35%) patients had leptomeningeal carcinomatosis. The initial procedure to treat hydrocephalus was a VPS in 13 (65%) patients
seven (35%) had an ETV first. Patients with a single brain metastatic lesion had a longer median overall survival (OS) than those with more than one metastatic site (154.5 versus 67.0 days). Our cohort had a similar median OS following the ETV/VPS procedure compared to published data (92.5 versus 91 days). In both ETV and VPS subsets, our cohort had a longer median OS than published data: 106 versus 56 days for ETV and 79 versus 56 days for VPS. Conclusions: Patients with brain metastases and hydrocephalus who underwent an ETV or VPS placement had improved survival compared to historical controls and if they had only one metastatic lesion. Interdisciplinary evaluation of patients with brain metastases by neurosurgeons as well as medical and radiation oncologists is warranted to facilitate systemic therapy after hydrocephalus relief.