Emergency management of intracranial haemorrhage due to AVMs, DAVFs, and cavernomas involves addressing both the haemorrhage consequences and the underlying vascular lesion. Clinical evaluation and diagnostic workup identify factors necessitating urgent intervention and define the vascular lesion. Urgent intervention may involve ICH management with increased ICP or CSF drainage for acute hydrocephalus. Definitive intervention for the vascular lesion may coincide with or follow evacuation of the intracranial haematoma. Careful considerations and precautions are taken independently or concurrently with the vascular lesion. Indications and timing for AVM intervention involve determining the bleeding source, evaluating mass effect, and assessing the utility of existing ICH for microsurgical AVM resection. Modified microsurgical techniques ensure safety. DAVF intervention with ICH or ASDH requires urgent endovascular treatment and surgical nuances. Cavernoma intervention follows straightforward indications and timing, while brainstem cavernomas require careful consideration of early intervention. Aftercare and a team approach are vital.

The ruptured aneurysm with an intracerebral haematoma is a commonly encountered neurosurgical emergency. The options for management of this situation have evolved with the changes in neurovascular surgery training and widespread use of endovascular techniques for aneurysm occlusion. This Element will discuss the differences between subarachnoid haemorrhage with or without an intracerebral haematoma including presentation, imaging and outcomes. The authors present their preferred surgical strategy including practical guidance on how to handle difficult situations such as the intra-operative rupture.