Postoperative Rebleeding: The Sword of Damocles in Minimally Invasive Surgery for Intracerebral Hemorrhage

Intracranial hemorrhage (ICH) represents a subtype of stroke characterized by increased mortality and disability rates. Early evacuation of the hematoma is essential for the effective management of ICH. Currently, minimally invasive surgery (MIS) has emerged as a promising alternative to traditional craniotomy by offering advantages, such as reduced operating time, minimal surgical trauma, and accelerated recovery. Nonetheless, postoperative rebleeding remains an important complication that adversely affects the functional outcomes and survival rates of the affected patients. Thus, acquiring a thorough understanding of postoperative rebleeding following MIS for ICH is crucial for enhancing neurological functional outcomes. This review aimed to synthesize current evidence regarding the definition of postoperative rebleeding following MIS for ICH, elucidate the mechanisms contributing to this phenomenon, and identify the associated risk factors, including both surgical and patient-related factors. In addition, the review discusses contemporary strategies for the prevention and management of postoperative rebleeding. Furthermore, it explores prospective advances in dynamic risk prediction and early detection of postoperative rebleeding using artificial intelligence and real-time biosensors. This review offers a reference for clinical practice and guides future studies aimed at reducing the risk of postoperative rebleeding after MIS for ICH, thereby enhancing the outcomes of patients.