BACKGROUND AND IMPORTANCE: The amount of subarachnoid blood and the presence of toxic blood breakdown products in the cerebrospinal fluid (CSF) have long been associated with poor outcomes in aneurysmal subarachnoid hemorrhage. The Neurapheresis™ system (Minnetronix Inc, St. Paul, Minnesota) has been developed to filter CSF and remove blood products, and is being investigated for safety and feasibility in the ExtracorPoreal FILtration of subarachnoid hemorrhage via SpinaL CAtheteR (PILLAR) study. We report the first case using this novel device. CLINICAL PRESENTATION: A 65-yr-old female presented with a ruptured left posterior communicating artery aneurysm. Following placement of a ventriculostomy and coil embolization of her aneurysm, the patient underwent placement of a lumbar dual lumen catheter for CSF filtration as part of the PILLAR study. In this case, a total of 9 h of filtration during 31 h of catheter indwelling resulted in 309.47 mL of processed CSF without complication. Computed tomography images demonstrated an interval reduction of subarachnoid hemorrhage immediately after filtration. The patient was discharged home on postbleed day 11 and at 30 d showed good recovery. CONCLUSION: Safety of the Neurapheresis procedure was confirmed in this first case, and we will continue to evaluate safety of the Neurapheresis system through the PILLAR trial.
Bibliographical noteFunding Information:
This publication is not supported by any company or grant funding. The PILLAR clinical trial is supported by Minnetronix Inc. Two co-authors, Dr Verbick and Dr McCabe, are employed by Minnetronix and facilitated data interpretation and preparation of manuscript and figures. Dr Lad has consulted for Minnetronix Inc. He is the coinventor of the Neurapheresis Therapy and is involved in its scientific development. He is not involved in PILLAR clinical enrollment. Dr Blackburn, Dr Swisher, and Dr Grande are site principal investigators and do not receive compensation for the study other than Institutional Review Board approved study related expenses. Ms Rubi has no personal, financial, or institutional interest in any of the drugs, materials, or devices described in this article.
Copyright © 2018 by the Congress of Neurological Surgeons.
- Cerebrospinal fluid filtration
- Lumbar drain
- Subarachnoid hemorrhage