title: Minimally invasive evacuation of intraventricular hemorrhage with the Apollo vibration/suction device.
abstract: Intraventricular hemorrhages (IVH) can occur as a consequence of spontaneous intracerebral hemorrhage, aneurysm rupture, arteriovenous malformation hemorrhage, trauma, or coagulopathy. IVH is a known risk factor for poor clinical outcome with up to 80% mortality. The current standard treatment strategy for IVH consists of the placement of an external ventricular drain. We report our early experience with using the Apollo suction/vibration aspiration system (Penumbra, Alameda, CA, USA) for minimally invasive evacuation of IVH with a review of the pertinent literature. Medical records of patients with IVH who were admitted to Rush University Medical Center, USA, from July to November 2014 were queried from the electronic database. Patients with Graeb Scores (GS) >6 were selected for minimally invasive IVH evacuation with the Apollo aspiration system. Patient demographics, pre- and post-operative GS, pre- and post-operative modified Graeb Score (mGS), as well procedure related complications were analyzed and recorded. A total of eight patients (five men) were identified during the study period. The average age was 55.5years. The mean GS was 9.6 pre-operatively and decreased to 4.9 post-operatively (p=0.0002). The mean mGS was 22.9 pre-operatively and decreased to 11.4 post-operatively (p=0.0001). Most of the IVH reduction occurred in the frontal horn and atrium of the lateral ventricle, as well the third ventricle. One (1/8) procedure-related complication occurred consisted of a tract hemorrhage. The Apollo system can be used for minimally invasive IVH evacuation to achieve significant blood clot volume reduction with minimal procedure-related complication.
authors.affiliation: Department of Neurosurgery, Rush University Medical Center, 1725 W. Harrison Street, #855, Chicago, IL 60612, USA.
authors.forename: Lee A
authors.initials: LA
authors.lastname: Tan
authors.affiliation: Department of Neurosurgery, Rush University Medical Center, 1725 W. Harrison Street, #855, Chicago, IL 60612, USA.
authors.forename: Demetrius K
authors.initials: DK
authors.lastname: Lopes
authors.affiliation: Department of Neurosurgery, Rush University Medical Center, 1725 W. Harrison Street, #855, Chicago, IL 60612, USA.
authors.forename: Lorenzo F
authors.initials: LF
authors.lastname: Munoz
authors.affiliation: Department of Neurosurgery, Rush University Medical Center, 1725 W. Harrison Street, #855, Chicago, IL 60612, USA.
authors.forename: Yojan
authors.initials: Y
authors.lastname: Shah
authors.affiliation: Department of Neuroradiology, Rush University Medical Center, Chicago, IL, USA.
authors.forename: Sudeep
authors.initials: S
authors.lastname: Bhabad
authors.affiliation: Department of Neuroradiology, Rush University Medical Center, Chicago, IL, USA.
authors.forename: Miral
authors.initials: M
authors.lastname: Jhaveri
authors.affiliation: Department of Neurosurgery, Rush University Medical Center, 1725 W. Harrison Street, #855, Chicago, IL 60612, USA. Electronic address: roham.moftakhar@gmail.com.
authors.forename: Roham
authors.initials: R
authors.lastname: Moftakhar
mesh_terms: D000328:Adult; D000368:Aged; D002543:Cerebral Hemorrhage / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000009:adverse effects / Q000295:instrumentation* / Q000379:methods; D011183:Postoperative Complications / Q000453:epidemiology; D012307:Risk Factors; D013396:Suction / Q000009:adverse effects / Q000295:instrumentation* / Q000379:methods; D016896:Treatment Outcome
keywords: Apollo; Endoscopic; Graeb score; Intraventricular hemorrhage; Minimally invasive; Modified Graeb score