Abstract
IntroductionNovel image-guided, minimally invasive techniques to evacuate intracerebral hematomas represent a promising new avenue in the management of this disease entity. To our knowledge, a direct comparison of the Penumbra Apollo (Penumbra Inc, Alameda, California, US) and Nico BrainPath (Indianapolis, Indiana, US) system has not yet been performed.MethodsA retrospective review of image-guided, minimally invasive evacuation of intracerebral hematomas performed at one academic institution in the United States between July 2015 and July 2017 was performed. Cases performed with the Apollo and BrainPath system were matched based on age, gender, hematoma location and laterality, and volume.ResultsTwenty-four patients underwent surgery using either of the two minimally invasive surgical systems and five cases in each group were matched for age, gender, hematoma location and laterality, and volume. Median time from symptom onset to evacuation was two days with a mean distance from the brain surface to the clot of approximately 40 millimeters in both groups. Both techniques achieved comparable clot evacuation. The functional outcome was poor with either technique with the majority of patients dependent or dead at last follow-up.ConclusionsIn the present, small, matched cohort study, both the Apollo and BrainPath techniques achieved satisfactory clot evacuation. Nevertheless, the functional outcome in this patient population remains poor in the majority of cases.
Highlights
Novel image-guided, minimally invasive techniques to evacuate intracerebral hematomas represent a promising new avenue in the management of this disease entity
Cases performed with the Apollo and BrainPath system were matched based on age, gender, hematoma location and laterality, and volume
The subsequent release of blood products and proteins from the hematoma heralds the second phase of post-intracranial hemorrhages (ICHs) injury and represents a target for therapeutic intervention
Summary
A retrospective review of image-guided, minimally invasive evacuation of intracerebral hematomas performed at one academic institution in the United States between July 2015 and July 2017 was performed. Cases performed with the Apollo and BrainPath system were matched based on age, gender, hematoma location and laterality, and volume. A retrospective review of image-guided, minimally invasive ICH evacuations using either the Apollo or the BrainPath system between July 2015 and July 2017 at one academic institution in the United States was performed. ICH characteristics (i.e. location, laterality, volume, associated intraventricular hemorrhage (IVH), and etiology), clinical presentation (i.e. Glasgow coma scale (GCS) upon admission), treatment parameters (i.e. time from onset to evacuation, postoperative volume), and outcome (i.e. GCS upon discharge, length of stay, modified Rankin score (mRS) on last follow-up) were recorded. Cases performed with the Apollo and BrainPath systems were matched in a stepwise fashion based on age, gender, hematoma location and laterality, and volume
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