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However, few investigations have delineated factors predicting preoperative hydrocephalus. This study aimed to identify risk factors for hydrocephalus prior to tumor resection in the posterior cranial fossa and to develop a predictive scoring model. We reviewed 421 patients with posterior cranial fossa tumors, stratifying them into groups with (\n                    <jats:italic>n<\/jats:italic>\n                    \u2009=\u2009160, 38%) and without (\n                    <jats:italic>n<\/jats:italic>\n                    \u2009=\u2009261, 62%) hydrocephalus on initial neuroimaging. Demographic, radiographic, and craniometric variables were collected. Univariate and multivariable logistic regression analyses were performed, and odds ratios with 95% confidence intervals were determined. Factors that remained significant in the multivariable model were incorporated into a novel scoring system. Multiple factors were associated with preoperative hydrocephalus in univariate analysis. In the final multivariable model, increased intracranial pressure, ataxia, cognitive impairment, large tumor volume, and peritumoral vasogenic edema showed strong correlations with hydrocephalus. Pre-resection hydrocephalus in patients with posterior cranial fossa tumors was strongly associated with clinical symptoms (increased intracranial pressure, ataxia, and cognitive impairment) and radiographic findings (large tumor volume and peritumoral vasogenic edema). These results may guide early surveillance and facilitate surgical prioritization to avert severe complications in this patient population.\n                  <\/jats:p>","DOI":"10.1007\/s10143-025-03752-2","type":"journal-article","created":{"date-parts":[[2025,8,19]],"date-time":"2025-08-19T00:52:47Z","timestamp":1755564767000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Predictors of pre-resection hydrocephalus in posterior cranial fossa tumors: development of a predictive scoring model"],"prefix":"10.1007","volume":"48","author":[{"given":"Piriya","family":"Kanjanakangwankul","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bunpot","family":"Sitthinamsuwan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chanon","family":"Ngamsombat","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chottiwat","family":"Tansirisithikul","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sarun","family":"Nunta-aree","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2025,8,19]]},"reference":[{"key":"3752_CR1","first-page":"553","volume":"119","author":"HN Bray","year":"2022","unstructured":"Bray HN, Sappington JM (2022) A review of posterior fossa lesions. 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