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We describe the approaches for endoscopic hematoma evacuation for thalamic hemorrhage with ventricular perforation. We suggest minimum invasive surgical approaches to evacuate thalamic hematomas that are divided into the following four types based on the location of the hematoma and ventricular perforation point: Anterior-medial type, posterior-medial type, medial type, and lateral type. A transcortical intraventricular puncture via the anterior horn of the lateral ventricle is suitable for the anterior-medial type and medial type, via the ipsilateral posterior horn of the lateral ventricle is recommended for the posterior-medial type, and a transcortical puncture via just above the hematoma is suitable for the lateral type of thalamic hematomas. We suggest that the posterior-medial type is the best indication for endoscopic evacuation; however, appropriately selecting the surgical approach for thalamic hematomas with ventricular perforation may contribute to good post-operative outcome.

Approaches for Endoscopic Hematoma Evacuation for Thalamic Hemorrhage with Ventricular Perforation