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Updated: Apr 17, 2026
Minimally Invasive Endoscopic Intracerebral Hemorrhage Evacuation
Published on: October 15, 2021
Initial multicenter technical experience with the Apollo device for minimally invasive intracerebral hematoma
Alejandro M Spiotta1, David Fiorella, Jan Vargas
1*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.
Background:
No conventional surgical intervention has been shown to improve outcomes for patients with spontaneous intracerebral hemorrhage (ICH) compared with medical management.
Objective:
We 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).
Methods:
Institutional 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.
Results:
Twenty-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).
Conclusion:
Minimally 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.
