The aim of this work is to study the role of direct excision without preoperative diversion in cases of hydrocephalus caused by posterior fossa tumours, and to asses the considerations under which such patients would require early postoperative CSF diversion according to symptoms, complications, morbidity, subsequent quality of life and mortality. A review of literature and recent publications is presented, demonstrating various pathologies of posterior fossa tumours as regards their locations, behaviour and imaging. The opposing lines of management are presented, factors that may predetermine or indicate the slight possibility of development of postoperative hydrocephalus and the need for permanent diversion are thoroughly analysed. We conclude that expeditious direct excision of posterior fossa tumours, without preoperative CSF diversion, is a safe and effective line of management of posterior fossa tumours associated with hydrocephalus, except in cases with severe hydrocephalus presenting with severely altered conscious level and unavailable facilities for direct surgery, or inexcisable tumours as brainstem gliomas. Combined with adopting an expectant perioperative follow-up of patients at risk of development of postoperative hydrocephalus, complications associated with perioperative shunting are avoided, that are deemed by many as unnecessary in almost more than two thirds of patients undergoing posterior fossa tumour surgery