Introduction: Intraventricular hemorrhage (IVH) often occurs as a consequence of spontaneous intracerebral hemorrhage (ICH), aneurysm rupture, or arteriovenous malformation (AVM) hemorrhage. The presence of IVH is a known risk factor for poor clinical outcome and increased mortality. Current treatment strategies include the placement of external ventricular drain (EVD) and the possibility of fibrinolytic therapy is being through EVD is being examined. We report our early experience with using the Apollo aspiration/vibration system for minimally invasive evacuation of IVH with a review of the pertinent literature.

Methods: Medical records of patients with IVH who were admitted to Rush University Medical Center from July to November 2014 were queried from the electronic database. Patients with Graeb Scores >6 were selected for minimally invasive IVH evacuation with the Apollo aspiration system. Patient demographics, primary diagnoses, pre- and post-operative Graeb Scores (GS), pre- and post-operative modified Graeb Score (mGS), as well procedure related complications were analyzed and recorded.

Results: A total of eight patients (5 men, 3 women) were identified during the study period. The average age was 55.5 years. The mean pre-operative GS was 9.6, mean pre-operative mGS was 22.9; the mean post-operative GS was 4.9, mean post-operative mGS was 11.4. One (1/8) complication occurred consisted of a tract hemorrhage. No procedure-related infection occurred during the study period. There was significant reduction in IVH volume after the procedure as reflected by a decrease in mean GS and mean mGS of 4.9 and 11.5 points, respectively.

Conclusions: The Apollo system can be safely used for minimally invasive IVH evacuation to achieve significant blood clot volume reduction. Future multi-centered studies are needed to further investigate its impact on long term clinical outcome.

Patient Care: The minimally invasive evacuation of IVH offers immediate removal of intraventricular clot, which may potentially decrease the need to VPS, shor,ten hospital stay improve clinical outcome,and decrease mortality associated with IVH.

Learning Objectives: 1) Describe the impact of the presence of IVH on clinical outcome and mortality rate. 2)Discuss pathophysiology of IVH and related complications. 3) Identify current and investigational treatment strategies for IVH.

References: 1. Li Y, Zhang H, Wang X, She L, Yan Z, Zhang N, et al.: Neuroendoscopic surgery versus external ventricular drainage alone or with intraventricular fibrinolysis for intraventricular hemorrhage secondary to spontaneous supratentorial hemorrhage: a systematic review and meta-analysis. PloS One 8:e80599, 2013 2. Morgan TC, Dawson J, Spengler D, Lees KR, Aldrich C, Mishra NK, et al.: The Modified Graeb Score: An Enhanced Tool for Intraventricular Hemorrhage Measurement and Prediction of Functional Outcome. Stroke 44:635–641, 2013 3. Spiotta AM, Fiorella D, Vargas J, Khalessi A, Hoit D, Arthur A, et al.: Initial Multicenter Technical Experience With the Apollo Device for Minimally Invasive Intracerebral Hematoma Evacuation. Neurosurgery:2015 4. Turner RD, Vargas J, Turk AS, Chaudry MI, Spiotta AM: Novel device and technique for minimally invasive intracerebral hematoma evacuation in the same setting of a ruptured intracranial aneurysm: combined treatment in the neurointerventional angiography suite. Neurosurgery 11 Suppl 2:43–51, 2015 5. Ziai WC, Tuhrim S, Lane K, McBee N, Lees K, Dawson J, et al.: A multicenter, randomized, double-blinded, placebo-controlled phase III study of Clot Lysis Evaluation of Accelerated Resolution of Intraventricular Hemorrhage (CLEAR III). Int J Stroke Off J Int Stroke Soc 9:536–542, 2014