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

We assessed the technical utility and preliminary outcomes of endoscopic hematoma evacuation via the high parietal approach for thalamic hemorrhage with intraventricular extension (intraventricular hemorrhage) by retrospectively reviewing 270 patients treated between April 1, 2006, and July 31, 2024. Prior to 2017, the primary treatment was external ventricular drainage, and in selected patients with thick intraventricular hematoma, an anterior endoscopic approach was used primarily for intraventricular hemorrhage removal. Since April 2017, the high parietal approach technique has been used for the simultaneous removal of both thalamic hematoma and intraventricular hemorrhage in 21 patients. The high parietal approach group showed a median hematoma evacuation rate of 92.2% and, compared with the external ventricular drainage-only group, a significantly shorter duration of ventricular drainage and a lower incidence of tracheostomy. No cases of surgical site infection or meningitis occurred in the high parietal approach group. Complications included 1 death due to postoperative rebleeding and another due to worsening pneumonia and heart failure. Secondary hydrocephalus requiring shunt placement was observed only in the external ventricular drainage group. Although not statistically significant, the high parietal approach group showed a higher rate of early resumption of oral intake. These findings suggest that endoscopic evacuation via the high parietal approach is a minimally invasive technique that achieves high hematoma removal rates, facilitates early postoperative recovery, and may reduce complications such as prolonged drainage, tracheostomy, and hydrocephalus in selected patients with large thalamic hemorrhage and intraventricular hemorrhage.