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 spontaneous cerebellar hemorrhage (SCH) patients. However, the long-term prognosis varies widely. Herein, we aimed to explore the prognostic risk factors of neurological outcome, including peri-operative hematoma and perihematomal edema (PHE), in SCH patients after MIS. Methods Eighty consecutive SCH patients, who underwent MIS between July 2019 and Nov. 2021 from 4 neurosurgical centers were enrolled prospectively. Patients were dichotomized into good (modified Rankin Scale (mRS) score ≤ 3) and poor neurological outcome (mRS score ≥ 4) groups. Peri-operative CT scans were assessed by two independent raters. Hematoma and PHE volume were calculated using 3D Slicer software. Predictors of poor neurological outcome were assessed in logistic regression models. Results Among the enrolled patients, 44 underwent endoscopic evacuation and 36 underwent MIC evacuation. The overall poor neurological outcome rate was 23.8%. Older patients, underwent MIC evacuation, large postoperative PHE, and large preoperative PHE (OR = 1.57, 95% CI: 1.20–1.90) were independently associated with poor neurological outcome. According to the restricted cubic splines analysis, patients were divided into large preoperative PHE subgroup (PHE ≥ 10 ml) and small preoperative PHE subgroup (PHE < 10 ml). In small preoperative PHE subgroup, 1 patient (2.4%) had poor neurological outcome. However, in large preoperative PHE subgroup, 18 patients (47.4%) had poor neurological outcome. Conclusion Large preoperative PHE is an independent risk factor for poor neurological outcome among SCH patients after MIS, especially when the preoperative PHE ≥ 10 ml.