To analyze the predictive ability of hematoma density heterogeneity on postoperative rebleeding in patients undergoing minimally invasive surgery (MIS) for intracerebral hemorrhage. Methods: Five hundred and fifteen patients with intracerebral hemorrhage, who were hospitalized in the Department of Emergency Neurology at the Affiliated Hospital of Guizhou Medical University from January 2015 to June 2022, were included in this study. All patients were treated with MIS. Based on the heterogeneity of hematoma density on cranial CT, patients were divided into a homogeneous hematoma density group (160 cases) and a heterogeneous hematoma density group (355 cases). Clinical and radiological data between the two groups were compared. Patients were further divided into a postoperative rebleeding group (59 cases) and a non-rebleeding group (456 cases) based on the presence or absence of postoperative rebleeding. Univariate analysis of postoperative rebleeding was conducted, and binary logistic regression model was used to analyze the correlation between the degree of hematoma density uniformity and postoperative rebleeding. Results: The incidence of postoperative rebleeding in the heterogeneous hematoma density group was 13.80%, which was higher than that in the control group (6.25% ) (P<0.05). Compared with the non-rebleeding group, the proportion of patients with a history of hypertension was lower (P<0.05), the proportion of patients with heterogeneous hematoma density was higher (P<0.05), and the modified Rankin Scale (mRS) score at discharge was higher (P<0.01) in the rebleeding group. Binary multivariate logistic regression analysis showed that heterogeneous hematoma density (OR=2.499, 95% CI 1.226-5.092, P=0.012) was an independent risk factor for postoperative rebleeding. Receiver operating characteristic curve analysis showed that the sensitivity, specificity, positive predictive value, negative predictive value, and Youden index of predicting postoperative rebleeding by heterogeneous hematoma density were 83.1%, 32.9%, 55.3%, 66%, and 0.16, respectively. Conclusion: Cranial CT hematoma density heterogeneity has certain predictive value for postoperative rebleeding in patients undergoing MIS for intracerebral hemorrhage.