Initial Multicenter Technical Experience With the Apollo Device for Minimally Invasive Intracerebral Hematoma Evacuation

Abstract

Minimally invasive evacuation of ICH and intraventricular hemorrhage can be achieved with the Apollo system. Future work will be required to determine which subset of patients are most likely to benefit from this promising technology.

Minimally Invasive Surgery for Intracerebral and Intraventricular Hemorrhage

“…Since approval, the system has been used clinically for the evacuation of both ventricular and cerebral hemorrhages (off-label). 23,24 In March of 2016, the clearence for the Apollo System was expanded with the current labeling: device is a nonclogging aspiration-irrigation system which allows the removal of hemorrhagic products through a low-profile (2.1 or 2.6 mm diameter) wand for the controlled aspiration of soft tissue and fluid during surgery of the ventricular system or cerebrum. A vibrational element housed within the wand vibrates at high frequency to break down the hemorrhagic products inside of the wand and prevent clogging.…”

“…25 The feasibility of the Apollo System for the removal of ICH has similarly been demonstrated in initial case reports. 23,24 Spiotta et al reported a retrospective analysis of 29 patients with ICH treated with the Apollo system at 4 centers. The authors reported a mean reduction in hemorrhage volume of 54%, with 2 procedural complications.…”

“…The authors reported a mean reduction in hemorrhage volume of 54%, with 2 procedural complications. 23 Although direct comparisons between the 2 techniques are not possible at this point, the BrainPath system in general seems to facilitate a more complete and aggressive removal of blood products and tissue, albeit through a considerably larger access port (13.5 mm versus 6.3 mm). More clinical data will be required to determine what extent of hematoma removal is required to effect a clinical improvement and whether the drawbacks of larger access are offset by the ability to achieve a more complete evacuation of blood products.…”

Long-Term Follow-up in Patients with Spontaneous Intracerebral Hemorrhage Treated With or Without Surgical Intervention: a Large-Scale Retrospective Study

“…The MISTIE phase II trial showed a trend towards improved outcomes in the surgical patients compared to those in the medically managed patients. In addition, the ongoing MISTIE III trial added a stereotactic CT-guided endoscopic surgery arm [18][19][20][21]. In the present study, we attempted to compare the short-term and long-term effectiveness of sICH treatment, including medical treatment (control) and surgical intervention (craniotomy and endoscope).…”

Intracerebral Hemorrhage: A Common and Devastating Disease in Need of Better Treatment

“…As opposed to the ICES technique, in most cases, no drainage catheters were placed following the initial evacuation 48 .…”