• Xueyun Deng, Jiuhong Li, Daibo Ke, Lihua Liu, Junpeng Ma, Jian Cheng, and Xuhui Hui.
• Department of Neurosurgery, West China Hospital of Sichuan University, Chengdu, Sichuan, China; Department of Neurosurgery, Nanchong Central Hospital, The Second Clinical Medical College of North Sichuan Medical College, Nanchong, Sichuan, China.
• World Neurosurg. 2020 Jan 1; 133: e218-e224.

ObjectiveDelayed postoperative hemorrhage (DPOH) was a severe postoperative complication after intracranial epidermoid cyst (EC) surgery. This study was designed to investigate possible clinical data and image features related to DPOH in patients with EC.MethodsWe retrospectively investigated 186 cases of EC, and 8 cases presented an appearance of DPOH. Preoperative magnetic resonance imaging (MRI) and clinical data (age, sex, chief surgeon, tumor size, tumor location, and degree of resection) were reviewed and analyzed. The Student t test and the χ2 test were used, and statistical significance was defined as P < 0.05.ResultsA total of 8 patients suffered from DPOH. Seven patients (87.5%) with DPOH showed atypical mixed signal intensity on preoperative T1 MRI compared with typical low intensity in another DPOH case. Only 1 case of mixed signal intensity on T1 MRI was found in 178 patients without DPOH. The mixed signal intensity on preoperative T1 MRI was highly related to DPOH and mortality (both P < 0.001). There was no significant difference in other relative clinical data between patients with or without DPOH.ConclusionsMixed signal intensity on preoperative T1 MRI might be associated with DPOH in patients with EC. The surgeon should pay more attention to this rarely atypical imaging before surgery. Further observations are necessary to illustrate the relationship between mixed signal intensity and DPOH in EC and to guide reasonable therapy.Copyright © 2019 Elsevier Inc. All rights reserved.

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