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Updated: Oct 29, 2026

Minimally Invasive Endoscopic Intracerebral Hemorrhage Evacuation
Published on: October 15, 2021
High Postoperative Perihematomal Edema Trajectory after Endoscopic Evacuation for Supratentorial Intracerebral
Shuang Liu1, Chen Li1, Shengyang Su2
1Department of Neurosurgery, Zhongshan Hospital, Fudan University, Shanghai, 200032, China.
Background And Objective:
The clinical relevance of perihematomal edema (PHE) after endoscopic evacuation of supratentorial intracerebral hemorrhage (ICH) is uncertain. We examined a longitudinal postoperative PHE phenotype and its association with 90-day functional outcome.
Methods:
This two-center retrospective cohort included 136 patients who survived beyond 72 h after endoscopic evacuation of supratentorial ICH and had complete serial computed tomography (CT) and 90-day modified Rankin Scale (mRS) assessment. CT windows were 0-24 h (T1), 48-72 h (T2), and day 5-7 (T3). Before outcome-model fitting, high postoperative PHE trajectory was defined as T3 PHE ≥ 36.6 mL or continuous increase across T1-T2-T3 with a T3-T1 change ≥ 7.7 mL; both thresholds were cohort-derived upper quartiles. Center-adjusted logistic regression examined associated factors and poor 90-day outcome (mRS score 3-6).
Results:
High postoperative PHE trajectory occurred in 51 patients (37.5%). Intraventricular hemorrhage (IVH) severity (adjusted odds ratio [aOR] 2.11 per category, 95% confidence interval [CI] 1.09-4.09), residual hematoma volume (aOR 1.75 per mL, 95% CI 1.35-2.27), and fever duration within 72 h (aOR 1.20 per h, 95% CI 1.08-1.34) were associated with this trajectory. Adding trajectory to the outcome model increased apparent area under the receiver operating characteristic curve (AUC) from 0.846 to 0.905; trajectory was associated with poor outcome (aOR 25.21, 95% CI 6.13-103.60). Among 131 paired observations, mRS score 0-2 occurred in 71/131 (54.2%) at 90 days and 76/131 (58.0%) at 12 months (two-sided exact McNemar P = 0.125).
Conclusions:
In this selected cohort of early postoperative survivors, IVH severity, residual hematoma volume, and fever duration were associated with high postoperative PHE trajectory, which was associated with poor 90-day functional outcome. This cohort-derived imaging phenotype warrants external validation as a candidate prognostic marker after endoscopic evacuation.
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