To explore effect of irregular hematoma morphology by preoperative CT on postoperative rebleeding in patients with spontaneous intracerebral hemorrhage after craniotomy. Methods: A total of 348 patients with intracerebral hemorrhage admitted to the neurosurgery department of Jinyang Hospital affiliated to Guizhou Medical University from January 2019 to September 2022 were consecutively enrolled. Based on postoperative rebleeding, they were divided into a postoperative rebleeding group (n=32) and a control group (n=316). According to the hematoma morphology, patients were divided into a regular hematoma morphology group (n=138) and an irregular hematoma morphology group (n=210). All patients underwent craniotomy. General clinical data, imaging data and postoperative complications were collected, and univariate analysis of related factors was performed. Factors with statistical significance (P<0.05) in the univariate analysis were further analyzed using binary logistic regression analysis to assess the predictive value of irregular hematoma morphology on postoperative rebleeding in patients with spontaneous intracerebral hemorrhage after craniotomy. Results: The incidence of postoperative rebleeding was higher in the irregular hematoma morphology group compared to the regular hematoma morphology group (12.86% v.s 3.62%), and there was a statistical difference between the two groups (P<0.05). Binary Logistic regression analysis revealed that irregular morphology could predict rebleeding in patients with intracerebral hemorrhage after craniotomy, with a sensitivity and specificity of 0.844 and 0.421, respectively. Conclusion: Irregular hematoma morphology was an independent risk factor for postoperative rebleeding in patients with intracerebral hemorrhage after craniotomy.