〔Abstract〕 Thalamic hemorrhage, a severe form of spontaneous intracerebral hemorrhage (ICH), accounts for 6% to 25% of all ICH cases. It is associated with high mortality, imposing a substantial burden on both patients and society. Current research on the surgical management ofthalamic hemorrhage primarily focuses on the indications, technical nuances, clinical outcomes, and complications of various surgical approaches. Stereotactic minimally invasive surgery for small-volume thalamic hemorrhage has been proven to improve patient prognosis, particularly for localized hematomas with a volume less than 15mL. However, a systematic and standardized evaluation of the efficacy across different surgical methods is still lacking. This review analyzes existing literatures to explore different surgical approaches for thalamic hemorrhage, including craniotomy, stereotactic minimally invasive evacuation, and neuroendoscopic evacuation, assessing their respective advantages and limitations. The analysis reveals that traditional craniotomy is being used less frequently in the treatment of deep-seated thalamic hemorrhage due to its significant invasiveness. Stereotactic minimally invasive surgery demonstrates advantages in effectively improving neurological outcomes and reducing mortality for small to moderate hematomas, while neuroendoscopic surgery offers unique value in evacuating intraventricular hematomas and reducing shunt dependency. Additionally, the timing of surgery has a significant impact on patient prognosis, although the optimal timing remains to be further clarified. Current evidence is largely derived from retrospective studies, highlighting the need for high-quality prospective research to provide a more robust foundation for clinical decision-making. This review aims to provide scientific evidence for clinical practice and to guide future research directions in this field.