Hematoma surface irregularity predicts postoperative rebleeding and poor drainage in patients with spontaneous intracerebral hemorrhage following minimally invasive surgery: a retrospective cohort study at a high-volume stroke center.

Background: The surface regularity index (SRI) reflects hematoma surface regularity in patients with intracerebral hemorrhage (ICH). Studies had reported an association between hematoma surface irregularity and hematoma expansion (HE). However, research on the correlation between the SRI and clinical outcomes in ICH patients following minimally invasive surgery (MIS) is limited. This study aimed to investigate the ability of the SRI to predict rebleeding and poor drainage in patients with spontaneous ICH following MIS.

Methods: The data of patients with ICH who underwent MIS between January 2021 to September 2022 at Beijing Tiantan Hospital, a high-volume stroke center, were retrospectively analyzed. The clinical, radiological, and surgical characteristics of the patients were systematically reviewed. The hematoma were segmented and constructed, and the SRI scores were estimated using image-processing software [three-dimensional (3D) Slicer] based on preoperative computed tomography (CT) scans. Univariate and logistic regression analyses were conducted to identify potential predictors for post-MIS rebleeding and poor drainage (defined as a residual hematoma >15 mL).

Results: A total of 151 ICH patients were included in the study, of whom 28 (18.5%) experienced post-MIS rebleeding, and 75 (49.7%) had poor drainage. The SRI was found to be independently associated with rebleeding [odds ratio (OR): 0.926, 95% confidence interval (CI): 0.891-0.963; P<0.001] and poor drainage (OR: 0.912, 95% CI: 0.882-0.944; P<0.001) after adjusting for confounders in the logistic regression. The area under the curve (AUC) of the receiver operating characteristic (ROC) curve of the SRI in predicting postoperative rebleeding was 0.765 (the cut-off point, sensitivity, and specificity were 44.980, 66.7%, and 82.1%, respectively), and that for poor drainage was 0.809 (the cut-off point, sensitivity, and specificity were 53.462, 61.8%, and 89.3%, respectively).

Conclusions: The hematoma SRI is an independent indicator of postoperative rebleeding and poor drainage in ICH patients following MIS.