Evakueringafintracerebralehæmatomermedminimal

invasivteknik

NielsSunde,RonniMikkelsen,SanjaKarabegovicogNielsHjortNeurokirurgisk,neurologiskogneuroradiologiskafdeling

AUH

Intracerebralthæmatom,alvorligprognoseogstorusikkerhedvedrørendeeffektenafkirurgiskbehandling.

� Udgørca10%afapoplexitilfælde

� Masseeffekt

� Toksiskeffekt- penumbra

Kirurgiskbehandling

Supratentoriel:kontroversielCerebellum:veletableret

Formål:� Dekompression,ophævemassevirkning,nedsætteICP

� Lukkeenevt.blødningskilde

� Reddefunktionsdygtigtvævidenomgivendepenumbrazone

Kirurgicontrakonservativbehandling

� STICH(tidligkirurgi(kraniotomi)modmedicinskbeh.)

� STICHII(somovenformennukunsuperficiellelobærehæmatomer)

� MISTIE(minimalinvasivkirurgimedactilysemodmedicinskbeh.)

� CLEARII(minimalinvasivkirurgimedintraventrikulæractilyse)

ICHlokalisation

Hæmatomevacueringviakraniotomi

Kanvigøredetbedre?

Manglendevidenskabeligdokumentationharførttilstorusikkerhedvedrørendeindikationenforkirurgisk

behandling

Evacueringafintracerebralehæmatomermedminimalinvasivteknik

Endoskopiskudstyr

TheApollo™ SystemWand

10

• Vacuum• Irrigation

• Proprietary, internal vibrational energy ensures rapid fluid/clot removal

• Material must extrude into tip under vacuum before vibration and irrigation can act

ConsistentUseOfVibrationWillEnsureExtraction

CourtesyofDr.RobyRyan,CommunityRegionalHospital

Aprospectivemulticenterrandomizedcontrolledpost-marketclinicalfollow-up(PMCF)studycomparingtheeffectivenessandsafetyoftheApolloSystem® versus

medicalmanagement(MM)forpatientswithintra-cerebralhemorrhage(ICH).

PrimaryEndpoint

� Effectiveness:modifiedRankinscore(mRS)of< 3at180days� Safety:Rateofmortalityat30days

Inclusion criteria(abbreviated)

1. Patientage≥18and≤80,orage<85withbaselinemRS=02. Supratentorial ICHofvolume≥20mL<80ml3. Hemostasis (hemorrhageincreaseoflessthan5mlasconfirmedby2CT/MR

takenaminimumof6hoursapart)4. NIHSS≥65. PresentingGCS5-156. HistoricalmRS 0or17. Symptomonset<24hpriorinitialCT8. ApolloMIEScanbeinitiatedwithin72hofictus/bleed9. SBPcanbecontrolled<180mmHgandsustainedatthislevelforatleast6hours10. WrittenInformedConsent

Exclusioncriteria

1. Imaginga) Expandinghemorrhageb) “Arterialspotsign”identifiedonCTAc) Hemorrhagiclesionsuchasavascularmalformation(cavernousmalformation,

AVMetc),aneurysm,neoplasmd) Hemorrhagicconversionofanunderlyingischemicstrokee) Infratentorialhemorrhagef) Largeassociatedintra-ventricularhemorrhagerequiringtreatmentforIVH-

relatedmasseffectorshiftduetotrappedventricle(EVDforICPmanagementisallowed)

g) Midbrainextension/involvement

InitialMulticenterTechnicalExperienceWiththeApolloDeviceforMinimallyInvasiveIntracerebralHematomaEvacuation

� Retrospektivanalyse� Gennemsnitsalder62år� VolumenafICH=45ml+/- 31ml� Efterevakuering22ml+/- 24ml� Komplikationertilprocedurenhos6,9%� Mortalitet13,8%

Neurokirurgi

NeuroradiologiNeurologi

Niels Sunde ,Neurokirurgisk afdeling, Aarhus Universitetshospital

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