Minimally invasive cone beam CT-guided evacuation of parenchymal and ventricular hemorrhage using the Apollo system: proof of concept in a cadaver model
Minimally invasive cone beam CT-guided evacuation of parenchymal and ventricular hemorrhage using the Apollo system: proof of concept in a cadaver model
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DOI：
10.1136/neurintsurg-2014-011293
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发表时间：
2015-08-01
影响因子：
4.8
通讯作者：
Schafer, Sebastian
中科院分区：
文献类型：
--
作者：
Fiorella, David;Arthur, Adam;Schafer, Sebastian
Apollo系统(美国加利福尼亚州Alameda，Penumbra Inc.)是一种用于颅内出血排空的低位冲洗-抽吸系统。目的论证Apollo结合锥束CT引导的可行性。方法采用经血管和经颅两种途径在身体头部制作脑实质血肿和脑室内混合血肿各1例。然后用锥束CT(CB-CT)对血肿进行成像，确定血肿的长轴。然后，CB-CT数据被用来指导经颅进入血肿-确定钻孔的位置和通向血肿前沿的路径。然后在活体透视引导下将8F血管鞘置入血肿内。进行第二次CB-CT检查以确定鞘的位置。然后在CB-CT上划定血肿范围，通过8F鞘引入Apollo棒，并在(定期)活体透视引导下进行冲洗-抽吸。操作者在血肿的可见边界内操纵魔杖。灌洗抽吸后行对照CB-CT检查，观察血肿体积缩小情况。结果经血管和经颅两种方法均可成功制造颅内血肿。血肿可以用CB-CT定位和体积测量的足够明显程度来定义。实时透视引导有效地引导鞘进入实质性血肿的前部，并使用Apollo系统引导冲洗-抽吸。冲洗抽吸脑实质出血量由189例S(实质出血)减少到1.7cc(第一例)，300例S(脑室内出血)从26.4 cc减少到4.1cc。结论所建立的身体模型是研究颅内出血介入技术的有效手段。使用Apollo系统通过微创经颅途径使用CB-CT来指导脑实质内和脑室内出血的清除似乎是可行的。
Introduction The Apollo system (Penumbra Inc, Alameda, California, USA) is a low profile irrigation-aspiration system designed for the evacuation of intracranial hemorrhage.Objective To demonstrate the feasibility of using Apollo in combination with cone beam CT guidance.Methods Parenchymal (n=1) and mixed parenchymal-intraventricular hematomas (n=1) were created in cadaver heads using a transvascular (n=1) or transcranial (n=1) approach. Hematomas were then imaged with cone beam CT (CB-CT), and the long axis of the hematoma defined. The CB-CT data were then used to guide transcranial access to the hematoma-defining the location of the burr hole and the path to the leading edge of the hematoma. An 8F vascular sheath was then placed under live fluoroscopic guidance into the hematoma. A second CB-CT was performed to confirm localization of the sheath. The hematoma was then demarcated on the CB-CT and the Apollo wand was introduced through the 8F sheath and irrigation-aspiration was performed under (periodic) live fluoroscopic guidance. The operators manipulated the wand within the visible boundaries of the hematoma. After irrigation-aspiration, a control CB-CT was performed to document reduction in hematoma volume.Results Transvascular and transcranial techniques were both successful in creating intracranial hematomas. Hematomas could be defined with conspicuity sufficient for localization and volumetric measurement using CB-CT. Live fluoroscopic guidance was effective in navigating a sheath into the leading aspect of a parenchymal hematoma and guiding irrigation-aspiration with the Apollo system. Irrigation-aspiration reduced the parenchymal hemorrhage volume from 14.8 to 1.7 cc in 189 s in the first case (parenchymal hemorrhage) and from 26.4 to 4.1 cc in 300 s in the second case (parenchymal and intraventricular hemorrhage).Conclusions The cadaver model described is a useful means of studying interventional techniques for intracranial hemorrhage. It seems feasible to use CB-CT to guide the evacuation of intraparenchymal and intraventricular hemorrhage using the Apollo system through a minimally invasive transcranial access.