We describe a method of endoscopic evacuation of combined thalamic and intraventricular hemorrhage. We used a steerable endoscope that was inserted into the anterior horn of the lateral ventricle contralateral to the thalamic hemorrhage in 4 cases. Because the volume of the hematoma in the lateral ventricle contralateral to the cerebral hemorrhage was smaller than that of the ipsilateral lateral ventricle, the hematoma in the contralateral lateral ventricle could be easily evacuated and sufficient orientation was obtained in the interior of the lateral ventricle. Hematoma in the third ventricle and the aqueduct of Sylvius could also be evacuated by the endoscope passed through the foramen of Monro. We then performed septostomy, and inserted the endoscope into the lateral ventricle ipsilateral to the cerebral hemorrhage. The hematoma in the ipsilateral lateral ventricle and the cerebral hemorrhage could be adequately evacuated. We conclude that approach to thalamic hemorrhage from the lateral ventricle contralateral to the cerebral hemorrhage through an opening placed in the septum pellucidum is useful for the treatment of combined thalamic and intraventricular hemorrhage.