Risk factors of recurrent hemorrhage following minimally invasive transcranial puncture and drainage in patients with spontaneous intracerebral hemorrhage: a retrospective cohort study

To explore the risk factors for recurrent hemorrhage in patients with spontaneous intracerebral hemorrhage (sICH) following minimally invasive transcranial puncture and drainage using a YL-1 hard-channel approach. Clinical data, CT imaging data, and follow-up information for patients with sICH who were continuously admitted to the Department of Neurosurgery from January 2021 to June 2025 were extracted from our hospital information system. All patients underwent minimally invasive transcranial puncture and drainage using a YL-1 hard-channel approach under CT guidance. Patients were categorized according to the occurrence of recurrent hemorrhage following surgery. Statistical analyses were conducted on the patients’ general clinical data, CT imaging data, and follow-up data. Univariate analysis and stepwise multivariate regression analysis were employed to identify relevant risk factors for postoperative recurrent hemorrhage (PRH). Additionally, the receiver operating characteristic curve (ROC) was utilized to further examine the independent risk factors and determine the cut-off value for predicting outcomes. A total of 159 patients was included in this study. Among them, 24 (15.1%) patients experienced recurrent hemorrhage after surgery. Univariate analysis indicated that a higher preoperative body mass index (BMI) ( P = 0.049), a larger postoperative dosage of urokinase (UK) ( P = 0.026), and a shorter time from onset to puncture (OPT) ( P = 0.001) were statistically associated with PRH. Among the preoperative CT imaging parameters, irregular hematoma shape ( P = 0.002) and the blend sign ( P = 0.001) were also statistically correlated with PRH. Multivariate binary logistic stepwise regression analysis revealed that a shorter OPT (OR = 1.223, 95% CI = 1.080–1.386, P = 0.002) and irregular hematoma shape (OR = 7.110, 95% CI = 1.840-17.473, P = 0.004) were independent risk factors for PRH. Conversely, the blend sign was associated with a reduced risk for PRH. (OR = 0.073, 95% CI = 0.012–0.108, P < 0.001). Additionally, plotting the ROC curve for OPT yielded an area under the curve (AUC) of 0.840, with an exploratory threshold of 10.5 h, corresponding to a sensitivity of 0.958 and a specificity of 0.778. A shorter OPT and an irregular hematoma shape are independent risk factors for recurrent hemorrhage following minimally invasive transcranial puncture and drainage using a YL-1 hard-channel approach in patients with sICH. In contrast, the blend sign may be associated to a lower risk of PRH. And these findings warrant further validation through external studies.