Objective To investigate the effect and prognosis of neuroendoscopy combined with unilateral external ventricular drainage tube alternating open drainage on patients with ventricular hemorrhage. Methods 96 patients with ventricular hemorrhage and hematoma cast in our department from June 2020 to August 2024 were selected as the study objects. The patients were divided into control group and study group by random number table method, with 48 cases in each group. In the control group, both external ventricular drainage tubes were simultaneously opened for drainage. In the study group, neuroendoscopy combined with unilateral external ventricular drainage tube was used for alternate open drainage. Perioperative indexes, postoperative complication rate, infection-related serum indexes [procalcitonin (PCT), C-reactive protein (CRP) and S-100b protein] and quality of life of the two groups were analyzed and compared. Results The cerebrospinal fluid recovery time, hematoma clearance time, drainage tube retention time and hospital stay in the study group were significantly shorter than those in the control group, and the residual hematoma in the first day after surgery was significantly lower than that in the control group (P < 0.05). After operation, the incidence of intracranial infection and rebleeding in the study group was significantly lower than that in the control group (P < 0.05). After treatment, the related serum indexes of procalcitonin, S-100b and C-reactive protein in both groups were significantly higher than before treatment, but the increase range of serum related indexes in the study group was significantly lower than that in the control group (P < 0.05). The ADl score of the study group was significantly higher than that of the control group (P < 0.05). Conclusion Neuroendoscopy combined with unilateral external ventricular drainage tube for the treatment of ventricular hemorrhage can improve perioperative indexes, promote patients" recovery, reduce the incidence of postoperative complications, and improve the quality of life.