Minimally invasive evacuation of parenchymal and ventricular hemorrhage using the Apollo system with simultaneous neuronavigation, neuroendoscopy and active monitoring with cone beam CT

David Fiorella, Fredrick Gutman, Henry Woo, Adam Arthur, Ricardo Aranguren, Raphael Davis

Research output: Contribution to journalArticle

18 Citations (Scopus)

Abstract

Introduction The Apollo system is a low profile irrigation-aspiration system which can be used for the evacuation of intracranial hemorrhage. We demonstrate the feasibility of using Apollo to evacuate intracranial hemorrhage in a series of three patients with combined neuronavigation, neuroendoscopy, and cone beam CT (CB-CT). Methods Access to the hematoma was planned using neuronavigation software. Parietal (n=2) or frontal (1) burr holes were created and a 19 F endoscopic sheath was placed under neuronavigation guidance into the distal aspect of the hematoma along its longest accessible axis. The 2.6 mm Apollo wand was then directed through the working channel of a neuroendoscope and used to aspirate the blood products under direct visualization, working from distal to proximal. After a pass through the hematoma, the sheath, neuroendoscope, and Apollo system were removed. CB-CT was then used to evaluate for residual hematoma. When required, the CB-CT data could then be directly uploaded into the neuronavigation system and a new trajectory planned to approach the residual hematoma. Results Three patients with parenchymal (n=2) and mixed parenchymal-intraventricular (n=1) hematomas underwent minimally invasive evacuation with the Apollo system. The isolated parenchymal hematomas measured 93.4 and 15.6 mL and were reduced to 11.2 (two passes) and 0.9 mL (single pass), respectively. The entire parenchymal component of the mixed hemorrhage was evacuated, as was the intraventricular component within the right frontal horn (single pass). No complications were experienced. All patients showed clinical improvement after the procedure. The average presenting National Institutes of Health Stroke Scale was 19.0, which had improved to 5.7 within an average of 4.7 days after the procedure. Conclusions The Apollo system can be used within the neuroangiography suite for the minimally invasive evacuation of intracranial hemorrhage using simultaneous neuronavigation for planning and intraprocedural guidance, direct visualization with neuroendoscopy, and real time monitoring of progress with CB-CT.

Original languageEnglish (US)
Pages (from-to)752-757
Number of pages6
JournalJournal of NeuroInterventional Surgery
Volume7
Issue number10
DOIs
StatePublished - Jan 1 2015
Externally publishedYes

Fingerprint

Neuroendoscopy
Neuronavigation
Cone-Beam Computed Tomography
Hematoma
Hemorrhage
Intracranial Hemorrhages
Neuroendoscopes
National Institutes of Health (U.S.)
Horns
Software
Stroke

All Science Journal Classification (ASJC) codes

  • Surgery
  • Clinical Neurology

Cite this

Minimally invasive evacuation of parenchymal and ventricular hemorrhage using the Apollo system with simultaneous neuronavigation, neuroendoscopy and active monitoring with cone beam CT. / Fiorella, David; Gutman, Fredrick; Woo, Henry; Arthur, Adam; Aranguren, Ricardo; Davis, Raphael.

In: Journal of NeuroInterventional Surgery, Vol. 7, No. 10, 01.01.2015, p. 752-757.

Research output: Contribution to journalArticle

@article{04a458a15b7144fea4ac0967561919ba,
title = "Minimally invasive evacuation of parenchymal and ventricular hemorrhage using the Apollo system with simultaneous neuronavigation, neuroendoscopy and active monitoring with cone beam CT",
abstract = "Introduction The Apollo system is a low profile irrigation-aspiration system which can be used for the evacuation of intracranial hemorrhage. We demonstrate the feasibility of using Apollo to evacuate intracranial hemorrhage in a series of three patients with combined neuronavigation, neuroendoscopy, and cone beam CT (CB-CT). Methods Access to the hematoma was planned using neuronavigation software. Parietal (n=2) or frontal (1) burr holes were created and a 19 F endoscopic sheath was placed under neuronavigation guidance into the distal aspect of the hematoma along its longest accessible axis. The 2.6 mm Apollo wand was then directed through the working channel of a neuroendoscope and used to aspirate the blood products under direct visualization, working from distal to proximal. After a pass through the hematoma, the sheath, neuroendoscope, and Apollo system were removed. CB-CT was then used to evaluate for residual hematoma. When required, the CB-CT data could then be directly uploaded into the neuronavigation system and a new trajectory planned to approach the residual hematoma. Results Three patients with parenchymal (n=2) and mixed parenchymal-intraventricular (n=1) hematomas underwent minimally invasive evacuation with the Apollo system. The isolated parenchymal hematomas measured 93.4 and 15.6 mL and were reduced to 11.2 (two passes) and 0.9 mL (single pass), respectively. The entire parenchymal component of the mixed hemorrhage was evacuated, as was the intraventricular component within the right frontal horn (single pass). No complications were experienced. All patients showed clinical improvement after the procedure. The average presenting National Institutes of Health Stroke Scale was 19.0, which had improved to 5.7 within an average of 4.7 days after the procedure. Conclusions The Apollo system can be used within the neuroangiography suite for the minimally invasive evacuation of intracranial hemorrhage using simultaneous neuronavigation for planning and intraprocedural guidance, direct visualization with neuroendoscopy, and real time monitoring of progress with CB-CT.",
author = "David Fiorella and Fredrick Gutman and Henry Woo and Adam Arthur and Ricardo Aranguren and Raphael Davis",
year = "2015",
month = "1",
day = "1",
doi = "10.1136/neurintsurg-2014-011358",
language = "English (US)",
volume = "7",
pages = "752--757",
journal = "Journal of NeuroInterventional Surgery",
issn = "1759-8478",
publisher = "BMJ Publishing Group",
number = "10",

}

TY - JOUR

T1 - Minimally invasive evacuation of parenchymal and ventricular hemorrhage using the Apollo system with simultaneous neuronavigation, neuroendoscopy and active monitoring with cone beam CT

AU - Fiorella, David

AU - Gutman, Fredrick

AU - Woo, Henry

AU - Arthur, Adam

AU - Aranguren, Ricardo

AU - Davis, Raphael

PY - 2015/1/1

Y1 - 2015/1/1

N2 - Introduction The Apollo system is a low profile irrigation-aspiration system which can be used for the evacuation of intracranial hemorrhage. We demonstrate the feasibility of using Apollo to evacuate intracranial hemorrhage in a series of three patients with combined neuronavigation, neuroendoscopy, and cone beam CT (CB-CT). Methods Access to the hematoma was planned using neuronavigation software. Parietal (n=2) or frontal (1) burr holes were created and a 19 F endoscopic sheath was placed under neuronavigation guidance into the distal aspect of the hematoma along its longest accessible axis. The 2.6 mm Apollo wand was then directed through the working channel of a neuroendoscope and used to aspirate the blood products under direct visualization, working from distal to proximal. After a pass through the hematoma, the sheath, neuroendoscope, and Apollo system were removed. CB-CT was then used to evaluate for residual hematoma. When required, the CB-CT data could then be directly uploaded into the neuronavigation system and a new trajectory planned to approach the residual hematoma. Results Three patients with parenchymal (n=2) and mixed parenchymal-intraventricular (n=1) hematomas underwent minimally invasive evacuation with the Apollo system. The isolated parenchymal hematomas measured 93.4 and 15.6 mL and were reduced to 11.2 (two passes) and 0.9 mL (single pass), respectively. The entire parenchymal component of the mixed hemorrhage was evacuated, as was the intraventricular component within the right frontal horn (single pass). No complications were experienced. All patients showed clinical improvement after the procedure. The average presenting National Institutes of Health Stroke Scale was 19.0, which had improved to 5.7 within an average of 4.7 days after the procedure. Conclusions The Apollo system can be used within the neuroangiography suite for the minimally invasive evacuation of intracranial hemorrhage using simultaneous neuronavigation for planning and intraprocedural guidance, direct visualization with neuroendoscopy, and real time monitoring of progress with CB-CT.

AB - Introduction The Apollo system is a low profile irrigation-aspiration system which can be used for the evacuation of intracranial hemorrhage. We demonstrate the feasibility of using Apollo to evacuate intracranial hemorrhage in a series of three patients with combined neuronavigation, neuroendoscopy, and cone beam CT (CB-CT). Methods Access to the hematoma was planned using neuronavigation software. Parietal (n=2) or frontal (1) burr holes were created and a 19 F endoscopic sheath was placed under neuronavigation guidance into the distal aspect of the hematoma along its longest accessible axis. The 2.6 mm Apollo wand was then directed through the working channel of a neuroendoscope and used to aspirate the blood products under direct visualization, working from distal to proximal. After a pass through the hematoma, the sheath, neuroendoscope, and Apollo system were removed. CB-CT was then used to evaluate for residual hematoma. When required, the CB-CT data could then be directly uploaded into the neuronavigation system and a new trajectory planned to approach the residual hematoma. Results Three patients with parenchymal (n=2) and mixed parenchymal-intraventricular (n=1) hematomas underwent minimally invasive evacuation with the Apollo system. The isolated parenchymal hematomas measured 93.4 and 15.6 mL and were reduced to 11.2 (two passes) and 0.9 mL (single pass), respectively. The entire parenchymal component of the mixed hemorrhage was evacuated, as was the intraventricular component within the right frontal horn (single pass). No complications were experienced. All patients showed clinical improvement after the procedure. The average presenting National Institutes of Health Stroke Scale was 19.0, which had improved to 5.7 within an average of 4.7 days after the procedure. Conclusions The Apollo system can be used within the neuroangiography suite for the minimally invasive evacuation of intracranial hemorrhage using simultaneous neuronavigation for planning and intraprocedural guidance, direct visualization with neuroendoscopy, and real time monitoring of progress with CB-CT.

UR - http://www.scopus.com/inward/record.url?scp=84941910889&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84941910889&partnerID=8YFLogxK

U2 - 10.1136/neurintsurg-2014-011358

DO - 10.1136/neurintsurg-2014-011358

M3 - Article

C2 - 25186443

AN - SCOPUS:84941910889

VL - 7

SP - 752

EP - 757

JO - Journal of NeuroInterventional Surgery

JF - Journal of NeuroInterventional Surgery

SN - 1759-8478

IS - 10

ER -