Background <p>Early postoperative cerebral infarction (ePCI) following spontaneous intracerebral hemorrhage (ICH) is a severe complication. This study aimed to develop and validate a cisterns and cortical sulci effacement (CCSE) score for predicting ePCI and to compare its predictive performance with that of established clinical scoring systems.</p> Methods <p>Data on spontaneous ICH from two centers were retrospectively analyzed. The visibility of 10 cisterns and the left/right cortical sulci was assessed on preoperative computed tomography scans (scored as 0 = visible, 1 = not visible), and the total sum constituted the CCSE score. Interrater and intrarater reliability were assessed using Cohen’s <i>κ</i> coefficient. Logistic regression and subgroup analyses were conducted to explore the association between CCSE and ePCI. Predictive performance was evaluated using receiver operating characteristic curves, and restricted cubic splines were used to assess potential nonlinearity.</p> Results <p>From a cohort of 3,968 consecutive patients with spontaneous ICH from May 2015 to September 2022, 637 individuals (mean age 57.3&#xa0;years [SD 12.5]; 71.3% male) were included in the final analysis, with 71 (11.1%) developing ePCI. The CCSE score showed excellent intrarater (<i>κ</i> = 0.93) and interrater (<i>κ</i> = 0.86) reliability and was strongly associated with ePCI risk (odds ratio 2.14 per point, 95% confidence interval [CI] 1.80–2.53, <i>p</i> &lt; 0.001). Subgroup analyses confirmed the robustness of the association. The CCSE score outperformed traditional scores, including the Glasgow Coma Scale, Original Intracerebral Hemorrhage Scale, and Modified Intracerebral Hemorrhage A score (area under the curve = 0.91; 95% CI 0.86–0.95). Additionally, a nonlinear relationship was identified (<i>p</i> for nonlinearity = 0.002), with a CCSE score threshold ≥ 4.02 for risk discrimination.</p> Conclusions <p>The CCSE score may be a reliable and practical tool for predicting ePCI in patients with supratentorial ICH.</p>