Surgical Approaches to The Hypothalamus: A Systematic Review of Anatomical Corridors and Postoperative Outcomes

Background: The hypothalamus is a vital neuroanatomical structure involved in endocrine, autonomic, and homeostatic regulation. Its deep location near critical neural and vascular structures makes surgical access complex. This review aims to evaluate and compare these surgical approaches, focusing on anatomical access and their clinical and functional outcomes. Methods: This review was conducted following PRISMA 2020 guidelines. A comprehensive search of PubMed and Scopus was performed for studies published between January 2000 and July 2025. Eligible studies included primary research on human patients undergoing surgical procedures targeting the hypothalamus, specifically reporting on anatomical corridors and postoperative outcomes. Where applicable, meta-analyses were conducted using random-effects models to pool outcome data and evaluate heterogeneity. Results: A total of 27 studies comprising 562 patients were analyzed. Hypothalamic hamartomas were the most common pathology (80.4%), with epilepsy being the predominant symptom (62.8%). Endoscopic approaches yielded the highest clinical improvement (88%) but with a slightly higher mortality (3%) compared to transcallosal (61% improvement, 0.5% mortality) and pterional approaches (60% improvement, 7.6% mortality). Lesion type and chosen surgical corridor significantly influenced outcomes. Conclusion: Endoscopic approaches showed the highest clinical improvement, while transcallosal routes offered the safest profile. Skull base approaches, such as orbitozygomatic, were associated with higher morbidity and should be used selectively. Publication History Article published online: 27 February 2026 © 2026. Thieme. All rights reserved. Georg Thieme Verlag KG Oswald-Hesse-Straße 50, 70469 Stuttgart, Germany