Novel Surgical ApproachNICO technologies are part of a minimally invasive systems approach designed to be a deficit-sparing neurosurgical procedure that integrates advanced imaging with navigation-compatible intervention technologies to achieve minimally disruptive ACCESS, automated REMOVAL and standardized, intra-operative COLLECTION and BIOLOGICALPRESERVATION of resected tissue.
WHAT WE DO
The BrainPath Approach integrateswith navigation and optics to achieve minimally-disruptive access.
A publication suggests that removal of abnormalities using BrainPath can result in less trauma to the patient and shorter recovery times.
Access the brain through thesulcus in a minimally disruptive way
Remove the lesion or hemorrhage using an automated tool
Collect in a closed-capture system and biologically preserve tissue for more comprehensive pathology and molecular analysis
Published Outcomes suggest that using the standardized BrainPath Approach and other integrated technologies contrib-ute to improved clinical outcomes, which lead to better economic returns.
Evidence also suggests that the BrainPath Approach provides economic value for the hospital when analyzing the entire episode of care and supports healthcare’s commitment to achieving Triple Aim.
ClinicoEconomics and Outcomes Research. 2017;9: 519-523.
To learn more about technologies used in the BrainPath Approach, visit NICOneuro.com.
View independently published peer-reviewed evidence from more than 60 clinical papers and abstracts.
Follow news updates.
View surgical videos and patient stories.
BrainPath Approach
HOW WE DO IT: ACCESS
BrainPath®Innovative and uniquely engineered device used for parafascicular, trans-sulcal access: • Primary and secondary brain tumors• Vascular abnormalities and malformations• Intraventricular tumors and cysts
See how BrainPath works
The BrainPath family of products includes 13.5mm and 11mm diameter devices in a variety of lengths to address multiple surgical needs.
BrainPath utilizes an opening about the size of a dime.
Safe access to the brain changes all decisions. The BrainPath Approach uses patented technologies to achieve minimally disruptive, navigable, trans-sulcal access through the subcortical space.
The Way You Access Mattersto achieve improved clinical and economic outcomes
meniGLIDE™
• Controlled opening of the meninges• Blunt dissection from underlying structures• Controlled incision along the superior membrane
The NICO meniGLIDE.
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See how meniGLIDE works
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THE IDEA OF USING A TRANS-SULCAL ROUTE IS NOT NEW THE TECHNOLOGY IS
Access
Why use Trans-sulcal access? • All tissue is relevant • Preserves healthy tissue during cannulation • Minimizes disruption to pial tissue enroute to lesion
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Why use a Parafascicular approach? • Designed to minimize shear forces applied to primary white matter tracts using DTI imaging • May reduce amount of brain transversed to each lesion • Fiber tract preservation
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SEE WHAT YOU WANT TO GET TOSAFELY REACH THE TARGET AREA
ACCESS for ICH Evacuation using BrainPath
ACCESS for Tumor Removal using BrainPath
Trans-sulcal approach to ICH evacuation with ventricular extension using the Myriad(1:00)
Mobilization of large sulcul vessel prior to cannulation and ICH evacuation using the Myriad(1:06)
Trans-sulcal approach accessing Foramen of Monroe for colloid cyst removal using Myriad (3:03)
Trans-sulcal approach to MET resection using Myriad (3:12)
Trans-sulcal approach to Cav Mal resection in dominant side pre-motor using Myriad(4:17)
Post-operative images reveal one of the differences between conventional brain surgery and surgery using BrainPath .
Conventional Brain Surgery Surgery Using BrainPath
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NICO technologies remove large tumors through small openingsTechnology for Corridor Access
A non-ablative, non-thermal, multi-functional device using mechanical cutting for improved access in narrow corridors.
TRIOwand™ - Hemostasis Control1 Irrigation 2 Variable suction 3 Coagulation• First integrated fluid management system for intracranial use• Single-use, hand-held device
The NICO Myriad.
Designed for corridor access and clearvisualization of the surgical field.
Monitors resection and addresses common visualization challenges.
The NICO TRIOwand.
Myriad™ - Automated Removal1 Scissors 2 Suction 3 Blunt dissector • Minimizes “in-and-out” of the surgical field• User-controlled variable aspiration • Tissue collection in a sterile, closed system
See how Myriad worksAutomated Abnormality Removal
HOW WE DO IT: REMOVAL
Used inside the BrainPath sheath to visualize landmarks and confirm:• Vascularity• Lesion position • Tumor roll
BrainPath Ultrasound Probe:Intraoperative, Real-Time Imaging
See how the BrainPath UltrasoundProbe works
BrainPath Ultrasound Probe by Hitachi Healthcare.
Removal
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Overcoming small corridor barriers PURSUING THE GOAL OFGROSS TOTAL RESECTION
Applying the Principles of Microsurgery with BrainPath
WORKING IN AIR MEDIUMColloid Cyst Removal (3:02)Air medium vs a fluid-filled environment for resection and hemostasis management using the BrainPath Approach
DIRECT VISUALIZATIONCavernous Angioma Removal (4:16)Extracorporeal HD imaging enabling equal light delivery to the surgical field during surgery using the BrainPath Approach
BI-MANUAL TECHNIQUEIntracerebral Hemorrhage Evacuation (1:06)Enabling a two-sucker technique with automated resection during surgery using the BrainPath Approach
HEMOSTASIS CONTROLBrain Metastasis Removal (3:12)Room for bipolar coagulation and view of the surgical site during surgery using the BrainPath Approach
Removal of Tumors and ICH using BrainPath
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HOW WE DO IT: COLLECTION & BIOLOGICAL PRESERVATION
Automated & Standardized Intra-operative Tissue Harvesting and Biological Preservation• Closed-capture system provides real-time, immediate refrigeration for desired thermal conditions• Ability to infuse/perfuse tissue creates the desired biological environment, which may aid tissue hydration • Heterogeneity of abnormalities can be accounted for due to increased quantity of tissue obtained • Enables the ability to capture and annotate tissue with correlation to specific intratumoral location for potential further advancements in personalized medicine2
Sealed chamber with automated infusion/perfusion to provide desired biological environment.
Meeting Today’s Modern Neuro-Oncology Needs
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Step 1 Automates the tissue collection process
Managing Intratumoral HeterogeneityProperly obtained and biologically preserved tissue matters in responding to personalized medicine therapies based on molecular features.1 Precision medicine advancements are driven by effective molecular analysis of tissue specimens that provide key information in tumor classification, disease prognosis, targeted treatment and therapies based on molecular features.
Step 2 Enables correlation of resected tissue samples to intratumoral location3
Step 3
Collection
Enables the efficient collection of greater tissue volume, the desired biological environment, and thermal conditions which may enable the pursuit of personalized medicine protocols of healthcare institutions
Third party navigation system
2 Intra-operative tracking of instrumentation (e.g., Myriad handpiece) is achieved using third-party equipment – refer to its labeling for proper use.
Compton MD PhD, Carolyn. Getting to personalized cancer medicine. CANCER, Oct 15 2007, Vol 10, Issue 8, pp. 1641-1643.
1 3 Proper segmentation of tissue areas require clearing/flushing the handpiece prior to changing the filter.
WHY WE DO IT: PATIENT OUTCOMESConventional Surgery vs BrainPath Approach WHAT PATIENTS WANT MOST
IN THEIR OWN WORDS
ICH: Most Deadly, Costly & Debilitating Form of Stroke
TOM CORBIN, back to work in2 months with no surgical deficits.
CATHY ALEXANDER,visit with mom saves her life.
GIGI GELVOSA,neurosurgical OR nurse’s life savedusing BrainPath.
Tumors: Account for 85-90% of all Primary CNS Tumors
BLAKELY MURPHY, 3-time brain tumor patient – 1 conventional surgery and 2 BrainPath surgeries.
ED CERNINKA, a second opinion provided a surgical option to a deep tumor he was told was inoperable.
RYAN VINCENT, 2-time brain tumor patient compares conventional vs BrainPath surgery.
NATIONAL SURVEY OF 1,000 PATIENTS
Retainbrain
function
Performbasic
physical tasks
Reducepain,
headaches
1 2 3
*In four of the above featured patient stories, it was the surgeon’s first time using the BrainPath Approach for tumor removal or hemorrhagic stroke clot evacuation.
PUBLISHED EVIDENCE
$12,000 Increase per Patient in Impact to Bottom Line*18
Clinical paper shows substantial economic benefit to hospital
Economic Benefit WebEx An Economic Analysis of the BrainPath Approach in Neurosurgery
Presented by Sid Norton Exec-utive Director VP, Budget & Finance Children’s Hospital of Cincinnati
Independently Published ECONOMIC DATA
OUTCOMES ACHIEVED CLINICAL & ECONOMIC
Independently Published PATIENT OUTCOMESTumor Removal Data
99% 0 0Surgicalrelated
mortalityN=252**
Cases with zero reported
complicationsN=214**
Reported Leptomeningeal
SpreadN=258**
45%Decrease in ICU LOS, the most
expensive venuein a hospital *17, 18
98.2%Median Clot Removal*20
<20 HrsICTUS to
Surgery*20
mRS <3In 63% of Patients*21
Decrease in ICU LOS*18
4 vs 12 Days
Vascular Treatment Data
BETTER PATIENT EXPERIENCEusing a standardized approach• Significant reductions in the ICU length of stay improves the patient experience of care • Patients in both ICH and tumor receive surgical intervention as treatment that previously would not have been eligible
The Triple Aim of Healthcare
IndependentlyPublished
CLINICAL DATAScan to access the Clinical Bibliography for papers onBrainPath and Myriad, andfor professional educationpresentations
• Greater than 50 percent average reduction in ICU length of stay• Average economic benefit to the hospital of $12,000 per patient for 28 patients • Net estimated benefit to the bottom line of $329,659
In 16 of 28 patients, BrainPath made it possible toprovide a surgical treatment not otherwise possible.*
Economic Benefit of BrainPath Surgery* for Appropriate Patients
ECONOMIC RETURN*Refer to Table 5 in published paper
$329,659
COST
54%REDUCED LOS
COST REDUCTIONS*18
Clinical outcomes associated with using NICOtechnologies and a standardized trans-sulcal,parafascicular surgical approach to address ICHand tumor removal have the support ofpeer-reviewed published evidence.
Featured on Cover of NEUROSURGERY
Lower CostThrough
Improvement
BetterHealthfor the
Population
BetterCareforIndividuals
Outcom
es
*All citations are located on back cover. **Aggregated data from *1-19; data on file.