To determine the value of the CT blend sign in predicting rebleeding after minimally invasive surgery (MIS) in patients with intracerebral hemorrhage (ICH).

The clinical data of patients with intracerebral hemorrhage, who were treated with MIS plus recombinant tissue plasminogen activator at Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology from July 2013 to June 2016, were analyzed retrospectively. Postoperative rebleeding was defined as an increase in hematoma volume of ≥5 ml assessed by CT compared with that on baseline or previous CT. The imaging features, clinical features and prognosis of rebleeding group and non-rebleeding group were compared. Logistic model was used to analyze the relationship between the appearance of blend sign and postoperative rebleeding.

A total of 294 patients were included and the rebleeding rate was 7.1% (21/294). The proportion of puncture damage was significantly higher in the rebleeding group than in the non-rebleeding group (47.6% vs 16.8%, χ²=10.061, P=0.002). Rebleeding occurred in 7 cases (7.0%) in the blend sign-positive group (n=100) and 14 cases (7.2%) in the blend sign-negative group (n=194), and there was no statistically significant (χ²=0.005, P=0.946). Multivariate logistic regression analysis demonstrated that the only independent predictor of postoperative rebleeding was puncture injury (OR=4.168, 95%CI: 1.649~10.537, P=0.003). CT blend sign did not predict the risk of rebleeding (OR=0.951, 95%CI: 0.357~2.533, P=0.920).

The CT blend sign on baseline CT did not imply the risk of rebleeding after MIS for ICH. Puncture injury is closely associated with postoperative rebleeding.