Endoscopic-assisted trans-lateral ventricular trans-choroidal fissure approach for evacuation of medial type thalamic hemorrhage: a case series.

Although surgeries for intracerebral hemorrhage remain controversial, endoscopic surgery is considered a promising surgical treatment. The most fatal type of thalamic hemorrhage is the medial type, which is always combined with expansion of the hematoma into the third ventricle. The current endoscopic approach to this lesion involves injury to the mediodorsal nucleus of the thalamus (MDT). We report five cases of medial thalamic hemorrhage with third intraventricular involvement treated by an endoscopic-assisted trans-lateral ventricular trans-choroidal fissure approach. The pre-operative average volume of the parenchymal hematomas was 9.63 ml, while the pre-operative average volume of the intraventricular hematomas was 23.35 ml. The average surgical duration was 80.6 min. No intra-operative MDT incision was needed in any patient. The evacuation rate of parenchymal and intraventricular hematomas was 74.21%-98.84% and 85.89%–99.51%, respectively. Three months after the surgery, the average Glasgow coma scale scores improved to 13.8 from 7.2 pre-operatively. No ventriculoperitoneal shunt was needed in any patient. The endoscopic-assisted trans-lateral ventricular trans-choroidal fissure approach is a safe and effective approach for evacuation of a medial thalamic hemorrhage with third intraventricular involvement. This approach allows parenchymal hematoma evacuation through the rupture of third ventricle without incising the MDT in the lateral ventricle.