High Parietal Endoscopic Approach for Thalamic Hemorrhage: Technical Nuances and Preliminary Outcomes

Area of Science:

• Neurosurgery
• Minimally Invasive Surgery
• Neurological Disorders

Background:

• Thalamic hemorrhage with intraventricular extension (IVH) poses significant management challenges.
• Traditional treatments include external ventricular drainage (EVD) and anterior endoscopic approaches.
• The high parietal approach (HPA) offers a novel technique for simultaneous hematoma removal.

Purpose of the Study:

• To evaluate the technical utility and outcomes of the endoscopic high parietal approach for thalamic hemorrhage with IVH.
• To compare HPA outcomes with traditional EVD-only treatment.
• To assess complication rates and functional recovery associated with HPA.

Main Methods:

• Retrospective review of 270 patients treated between April 2006 and July 2024.
• Comparison of patients treated with EVD-only versus the HPA technique (since April 2017).
• Analysis of hematoma evacuation rates, duration of ventricular drainage, complication incidence, and functional outcomes.

Main Results:

• The HPA group achieved a median hematoma evacuation rate of 92.2%.
• HPA was associated with significantly shorter ventricular drainage duration and lower tracheostomy incidence compared to EVD-only.
• No surgical site infections or meningitis were observed in the HPA group; secondary hydrocephalus was only seen in the EVD group.

Conclusions:

• Endoscopic evacuation via the HPA is a safe and effective minimally invasive technique for thalamic hemorrhage with IVH.
• HPA facilitates high hematoma removal rates and promotes early postoperative recovery.
• The HPA may reduce complications such as prolonged drainage, tracheostomy, and hydrocephalus in selected patients.