Objective   To elucidate predisposing factors for enlargement of hypertensive intracerebral hematoma (HICH) after craniotomy and dot evacuation for the prevention of hematoma enlargement and the reduction of morbidity and mortality.   Methods   Records of 47 patients undergoing craniotomy and clot evacuation within 24 h after onset from Jan 2006 to Jan 2008 were analyzed retrospectively. Postoperative hematoma enlargement was found in 10 patients. The predisposing factors inclusive of age

gender

diabetes mellitus

systolic blood pressure

underlying diseases for anticoagulation

liver diseases

history of brain hemorrhage or stroke

antihypertension medication

duration from HICH onset to commencement of operation

serum plasma fibrinogen level at the time of admission

and hemostasis during operation.   Results   Mono-agent logistic analysis showed a significant correlation between hemotoma enlargement with age

liver diseases

duration from HICH onset to commencement of operation

and difficult thorough hemostasis during operation (P0.05). Multivariate analysis with a logistic regression model showed a thorough hemostasis during operation could prevent HICH enlargement (OR 0.069

95%CI 0.006-0.789

P=0.031).   Conclusion   Thorough hemostasis during the operation is an important predisposing factor for HICH enlargement or recurrent hemorrhage.