Intracerebral hemorrhage posts a serious threat to human health. Thalamic hemorrhage bears the worst outcome among supratentorial intracerebral hemorrhage with a high rate of mortality and disability. Obstructive hydrocephalus caused by thalamic hemorrhage breaking into the ventricles is an independent predictor of prognosis. The efficacy of surgical treatment for thalamic hemorrhage is still controversial. However, with the development of neuroendoscopy in recent years, more and more studies have confirmed the potential advantages of endoscopy in the treatment of thalamic hemorrhage breaking into the ventricles, and the clearance rate of hematoma can reach more than 90%. Combined with the relevant studies in recent years, we found that neuroendoscopic microinvasive surgery is safe and effective in the treatment of thalamic hemorrhage breaking into the ventricles. Optimizing surgical approach according to the type of hemorrhage and the size of hematoma could improve the hematoma clearance rate and reduce the incidence of shunt-dependent hydrocephalus and other complications.