• Alejandro M Spiotta, David Fiorella, Jan Vargas, Alexander Khalessi, Dan Hoit, Adam Arthur, Jonathan Lena, Aquilla S Turk, M Imran Chaudry, Frederick Gutman, Raphael Davis, David A Chesler, and Raymond D Turner.
• *Medical University of South Carolina, Department of Neurosciences, Division of Neurosurgery, Charleston, South Carolina; ‡Stony Brook University Medical Center, Department of Neurosurgery, Stony Brook, New York; §University of San Diego, Department of Neurosurgery, San Diego, California; ¶University of Tennessee, Department of Radiology, Memphis, Tennessee; ‖Medical University of South Carolina, Department of Radiology and Radiological Sciences, Charleston, South Carolina.
• Neurosurgery. 2015 Jun 1;11 Suppl 2:243-51; discussion 251.

BackgroundNo conventional surgical intervention has been shown to improve outcomes for patients with spontaneous intracerebral hemorrhage (ICH) compared with medical management.ObjectiveWe report the initial multicenter experience with a novel technique for the minimally invasive evacuation of ICH using the Penumbra Apollo system (Penumbra Inc, Alameda, California).MethodsInstitutional databases were queried to perform a retrospective analysis of all patients who underwent ICH evacuation with the Apollo system from May 2014 to September 2014 at 4 centers (Medical University of South Carolina, Stony Brook University, University of California at San Diego, and Semmes-Murphy Clinic). Cases were performed either in the neurointerventional suite, operating room, or in a hybrid operating room/angiography suite.ResultsTwenty-nine patients (15 female; mean age, 62 ± 12.6 years) underwent the minimally invasive evacuation of ICH. Six of these parenchymal hemorrhages had an additional intraventricular hemorrhage component. The mean volume of ICH was 45.4 ± 30.8 mL, which decreased to 21.8 ± 23.6 mL after evacuation (mean, 54.1 ± 39.1% reduction; P < .001). Two complications directly attributed to the evacuation attempt were encountered (6.9%). The mortality rate was 13.8% (n = 4).ConclusionMinimally invasive evacuation of ICH and intraventricular hemorrhage can be achieved with the Apollo system. Future work will be required to determine which subset of patients are most likely to benefit from this promising technology.

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