While most intracranial tumors are managed electively, a subset present with time-critical deterioration necessitating emergent surgery. Evidence characterizing this population is limited and often restricted to single-pathology series. A comprehensive description across tumor types and indications can inform triage, operative planning, and counseling.

We conducted a retrospective descriptive study of patients who received emergent neurosurgical intervention for tumor-related indications. Cases were identified via operative logs, ICD and CPT codes, and cross-validated by manual chart review. Exclusions include elective procedures. Collected variables included demographics, presentation (e.g., vision changes, decreased consciousness, focal deficits, seizures), imaging features (e.g. degree of herniation); tumor category (e.g. sellar, primary vs metastatic); operative approach (e.g., endoscopic endonasal, craniotomy, CSF diversion), ICU utilization, complications and other outcomes for 30-day and 90-day interval.

There were fewer than 100 emergent cases: the most common indications are rapidly progressive visual loss from sellar/suprasellar masses, mass effect with neurologic decline from intra-axial tumors (high-grade glioma or metastasis), intratumoral hemorrhage (often metastatic or high-grade primary), and obstructive hydrocephalus from posterior fossa or ventricular lesions. ICU stays are two days or less, and in-hospital mortality was less than 5%.

Emergent tumor-related neurosurgical interventions at a high-volume tertiary center are infrequent yet heterogeneous, spanning sellar apoplexy to hemorrhagic intra-axial lesions. Patterns observed—rapid operative timelines, short ICU courses, low in-hospital mortality, and favorable early visual outcomes in sellar emergencies—support streamlined triage pathways and pathology-specific operative strategies. This descriptive cohort provides benchmark data for counseling, resource planning, and the design of future comparative effectiveness studies focused on timing of intervention and approach-specific outcomes in tumor-related emergencies.