Prognostic Significance of Preoperative Perihematomal Edema in Spontaneous Cerebellar Hemorrhage After Minimally Invasive Surgery

Background Minimally invasive surgery (MIS), including endoscopic evacuation and minimally invasive catheter (MIC) evacuation, has been widely used in patients with spontaneous cerebellar hemorrhage (SCH). However, the long-term prognosis varies widely. Herein, a case-control study nested within a multicenter cohort was conducted to explore the risk factors for unfavorable prognosis in patients with SCH after MIS. Methods The data on medical history, perioperative computed tomography scans, and 6-month prognosis of the observed patients were collected. A comparison of these variables between patients with favorable outcomes (modified Rankin Scale score <= 3) and those with unfavorable outcomes (modified Rankin Scale score >= 4) was conducted to investigate prognostic predictors. Results Eighty patients from four clinical centers were enrolled in the present study. Four factors including advanced age, MIC evacuation, large postoperative perihematomal edema (PHE), and large preoperative PHE were identified as independent risk factors for 6 month unfavorable neurological outcome. Subsequent analysis demonstrated that preoperative PHE serves as a reliable predictor of unfavorable neurological outcome at 6 months (area under the curve = 0.849). Based on restricted cubic spline analysis, patients were subsequently stratified into a large preoperative PHE (>= 10 ml) subgroup and a small preoperative PHE (< 10 ml) subgroup. The incidence of unfavorable outcomes in the large preoperative PHE subgroup (47.4%) was significantly higher than that in the small preoperative PHE subgroup (2.4%). Conclusions Advanced age, MIC evacuation, large preoperative PHE, and postoperative PHE are independent factors associated with unfavorable outcome in patients with SCH who underwent MIS. Significantly, the large preoperative PHE is an independent predictor for unfavorable long-term neurological outcome, particularly when the preoperative PHE is >= 10 ml.