Purpose of review <p>Despite decades of research, intraventricular hemorrhage (IVH) remains a devastating condition with high morbidity and mortality. Traditional external ventricular drains (EVDs) have long served as the cornerstone of surgical management but are limited by various complications. This review evaluates recent literature on continuous ventricular irrigation as an alternative approach to treating IVH.</p> Recent findings <p>Early data surrounding continuous ventricular irrigation systems, including retrospective comparative studies and case series are encouraging. However, existing randomized data are limited by small sample size and methodological flaws. Larger, ongoing studies such as ACTIVE and ARCH aim to provide more definitive evidence.</p> Summary <p>Continuous ventricular irrigation offers theoretical and practical advantages over static drainage in IVH patients, including enhanced clot clearance and improved catheter patency, particularly when combined with continuous thrombolytic therapy. Optimized protocols for irrigation rates, medication dosing, and timing are still being investigated. Robust clinical trials are necessary to validate the approach and establish best practices.</p>