Endoscopic Removal of Thalamic Hematoma: A Technical Note

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Abstract
Object: To minimize invasiveness, an endoscopic surgical technique under stereotactic guidance is described for removal of thalamic hematoma. Surgical technique: A burr hole is placed at a point 3 cm above the glabella and 3 cm lateral from the midline. A transcortical transventricular puncture is performed with a stainless steel tube under stereotactic guidance. The tube is mounted to a metal holder. Through this tube, a rod-lens working channel endoscope and surgical instruments are inserted for visualization of the thalamus and evacuation of the hematoma. Compared with the endoscopic approach through the shortest distance of viable brain tissue, this technique allows removal of the hematoma in the ventricular space and thalamus simultaneously. The case of one patient with thalamic hemorrhage and obstructive hydrocephalus, caused by an intraventricular blood clot, is reported for surgical demonstration. Conclusion: An endoscopic technique for removal of thalamic hematoma with the aid of stereotactic guidance, which allows precise targeting of the lesion, is reported.

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