The purpose of this study was to investigate the predictive value of computed tomography angiography (CTA) spot signs in predicting postoperative rebleeding after stereotactic minimally invasive surgery for spontaneous intracerebral hemorrhage (sICH). Methods: A retrospective analysis was conducted on patients with sICH who received stereotactic minimally invasive surgery combined with urokinase therapy at the Affiliated Hospital of Guizhou Medical University from January 2018 to February 2023. According to whether there was postoperative rebleeding, the patients were divided into rebleeding group and control group, and their clinical characteristics and imaging features were compared. According to the presence or absence of spot signs on CTA, the patients were divided into spot sign positive group and spot sign negative group, and their clinical data were compared. Multivariate binary logistic regression model was applied to analyze the relationship between spot signs and postoperative rebleeding, as well as the predictive value of spot signs for postoperative rebleeding. Results: A total of 221 patients with sICH were included in this study, including 64 cases of rebleeding (28.9%). Among them, 114 patients with spot sign positive had 46 cases of rebleeding (40.4%), while 107 patients with spot sign negative had 18 cases of rebleeding (16.8%), and there was a significant difference between the two groups (P<0.01). In univariate analysis, male sex, smoking history, and spot sign were risk factors for postoperative rebleeding. Multivariate binary logistic regression analysis showed that spot sign was an independent predictor of postoperative rebleeding (OR=3.177, 95% CI 1.673～6.032, P=0.000). The ROC curve analysis showed that the sensitivity, specificity, positive predicted value, negative predicted value and Youden index of the spot signs were 71.9% , 56.7% , 40.3% , 83.2% and 28.6% , respectively, with an AUC of 0.643 (95% CI 0.564～0.722, P=0.001). Conclusion: Baseline CTA spot signs positive may be a risk factor for increasing the risk of postoperative rebleeding after stereotactic minimally invasive surgery for sICH.