NICO Corporation

Dedicated to revolutionizing minimally invasive neurosurgery

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What is the incidence of primary brain tumors in the United States?

Primary Brain Tumor 87,000 new cases projected in the US in 2019

NICO Primary Brain Tumor Scan BrainPath Approach
Pre and post-op scans of a primary brain tumor removal using BrainPath
 

 

What challenges have been encountered with conventional surgical approaches?

  1. Morbidity – Complications – Edema2,3,4,6,7,8
  2. Hemostasis Management in MIS Approaches10
  3. Sub-Optimal Resection Rates with Intraventricular Tumors using Ventriculoscopes15,16,17
  4. For Goal of Biopsy: Under-grading Disease – Sampling Error – Scant Tissue Removal9,10,11,13,14

 

 

How does the MIPS approach with NICO’s integrated systems solution overcome these challenges?

Challenge #1 – Morbidity – Complications – Edema
Solution: Minimally disruptive, navigable access even to eloquent areas
BrainPath is designed for trans-sulcal access
BrainPath is designed for navigable, trans-sulcal access with an a-traumatic conical tip that gradually dilates the tissue during cannulation
BrainPath sheath
BrainPath sheath acts as a protective portal for displaced neural tissue
Challenge #2 – Hemostasis Management in MIS Approaches
Challenge #3 – Sub-Optimal Resection Rates with Intraventricular Tumors using Ventriculoscopes
Solutions: Room for Bimanual Microsurgical Technique and Automated Resection

  • Both the 13.5mm and 11mm BrainPath diameters can accommodate two hands in the surgical field to enable basic hemostatic principles of microsurgery to be applied.
  • Surgeons use a modified bipolar for arterial bleeding and patties with hemostatic agents and warm saline irrigation for venous bleeding.
  • Myriad NOVUS enables automated resection within the BrainPath corridor, especially useful on larger and/or fibrotic tumors.

 

Metastatic Brain Tumor Removal with BrainPath Approach-bimanual-microsurgical-technique

Challenge #4 – For Goal of Biopsy: Under-grading Disease – Sampling Error – Scant Tissue Removal

 

Solution: 

An effective way to preserve vasculature and fascicular anatomy while achieving a high yield of tissue collection

  • Myriad NOVUS collects all tissue that is resected through the device for post-procedural use. Tissue is collected in a sterile, closed tissue trap that mitigates tissue degradation by limiting the sample’s exposure to the atmosphere.
  • The Myriad NOVUS tissue trap holds ~ 10cc of tissue, and the clear-housing provides for easy viewing of the volume collected during the procedure.
  • Myriad NOVUS resects tissue in a mechanical, non-ablative/non-thermal format, so the architectural viability of the specimen is still maintained. With the cutter engaged, the Myriad NOVUS is capable of 1,400 bites of tissue (biopsies) per minute13.
  • Myriad NOVUS with a 3rd party navigation system enables correlation of resected tissue samples to intratumoral location.
  • Myriad NOVUS with the tissue collection/preservation components automate and standardize the intraoperative bio-specimen collection and preservation process, eliminating the need for a full-time employee to do so.
  • Myriad NOVUS with the tissue collection/preservation components allow for efficient automated collection of a greater volume of tissue while creating a biologically friendly environment for use in patient specific tissue studies and protocols.

NICO Automated Preservation System

NICO Myriad NOVUS Tissue Filter
NICO Myriad NOVUS Tissue Filter
NICO Myriad NOVUS Tissue Filter

 

 

Key Publications

Minimally Invasive Resection of Deep-seated High-grade Gliomas Using Tubular Retractors and Exoscopic Visualization19

Minimally Invasive Tubular Retractor-Assisted Biopsy and Resection of Subcortical Intra-axial Gliomas and other Neoplasms20

Minimally Invasive Transsulcal Resection of Intraventricular and Periventricular Lesions Through a Tubular Retractor System: Multicentric Experience and Results17

Transsulcal Parafascicular Surgery Using Brain Path® for Subcortical Lesions21

 

 

Citations

  1. Ostrom QT et al. CBTRUS Statistical Report: Primary Brain and Central Nervous System Tumors Diagnosed in the United States in 2011–2015. Neuro Oncol (2018) 20 (suppl 4). October 2018. https://academic.oup.com/neuro-oncology/issue/20/suppl_4
  2. Cao, L., C. Li, Y. Zhang, and S. Gui. Surgical resection of unilateral thalamic tumors in adults: approaches and outcomes. BMC Neurol 2015; 15:229 https://doi.org/10.1186/s12883-015-0487-x
  3. Kelly, P. J. Stereotactic biopsy and resection of thalamic astrocytomas. Neurosurgery 1989; 25:185-94; discussion 194-5 https://doi.org/10.1227/00006123-198908000-00006
  4. McGirt MJ et al. Association of surgically acquired motor and language deficits on overall survival after resection of glioblastoma multiforme. Neurosurgery. Vol 65, Issue 3, 2009, 463-470 https://doi.org/10.1227/01.NEU.0000349763.42238.E9
  5. Chang SM et al. Patterns of Care for Adults With Newly Diagnosed Malignant Glioma. JAMA. 2005;293(5):557-564. doi:10.1001/jama.293.5.557
  6. Hawasli AR et al. Stereotactic laser ablation of high-grade gliomas. Journal of Neurosurgery. Neurosurg Focus. 2014. doi:10.3171/2014.9.FOCUS14471
  7. Pruitt R et al. Complication avoidance in laser interstitial thermal therapy. Lessons Learned. Journal of Neurosurgery, 2016, doi:10.3171/2016.3.JNS152147
  8. Norred SE et al. Magnetic-resonance-guided laser induced thermal therapy for glioblastoma multiforme: A review. Biomed Research International. 2014: 761312. http://dx.doi.org/10.1155/2014/761312
  9. Jackson RJ. et al. Limitations of stereotactic biopsy in the initial management of gliomas. Neuro-Oncology. 2001 Jul; 3(3): 193–200. doi: [10.1093/neuonc/3.3.193]
  10. Jackson C. et al. Minimally Invasive Biopsies of Deep Seated Brain Lesions Using tubular retractors under exoscopic visualization. Journal of Neurological Surgery. https://doi.org/10.1055/s-0037-1602698
  11. Khatab S et al. Frameless image-guided stereotactic brain biopsies: emphasis on diagnostic yield. Acta Neurochir. 2014. 156:1441-1450 doi:10.1007/s00701-014-2145-2
  12. Malone et al. Complications Following Stereotactic Needle Biopsy of Intracranial Tumors. World Neurosurgery. Citation: World Neurosurg. (2015) 84, 4:1084-1089. http://dx.doi.org/10.1016/j.wneu.2015.05.025
  13. Data on file. Provided by Brian Dougherty, Rose Hulman Ventures.
  14. Gutt-Will M et al. Frequent Diagnostic Under-Grading in Isocitrate Dehydrogenase Wild-Type Gliomas due to Small Pathological Tissue Samples. Neurosurgery, nyy433, https://doi.org/10.1093/neuros/nyy433
  15. Sheikh et al. Endoscopic verses microsurgical resection of colloid cysts; a systemic review and meta-analysis of 1278 patients. World Neurosurgery. 2014; 82:1187-1197
  16. Mohanty A et al. Initial experience with endoscopic side cutting aspiration system in pure neuroendoscopic excision of larger intraventricular tumors. World Neurosurgery. 2013; 80(5) https://doi.org/10.1016/j.wneu.2012.11.070
  17. Bailes J et al. Minimally Invasive Transsulcal Resection of Intraventricular and Periventricular Lesions Through a Tubular Retractor System: Multicentric Experience and Results. World Neurosurgery. 2016. https://dx.doi.org/10.1016/j.wneu.2015.12.100
  18. Kassam AB et al. Part II: an evaluation of an integrated systems approach using diffusion-weighted, image-guided, Exoscopicassisted, transulcal radial corridors. Innovative Neurosurgery. 2015; 3(1-2): 25-33. http://dx.doi.org/10.1515/ins-2014-0012
  19. Chaichana et al. Minimally invasive resection of deep-seated high-grade gliomas using tubular retractors and exoscopic visualization. Journal of Neurosurgery. J Neurol Surg A Cent Eur Neurosurg DOI: 10.1055/s-0038-1641738
  20. Gassie K et al. Minimally invasive tubular retractor-assisted biopsy and resection of subcortical intra-axial gliomas and other neoplasms. Journal of Neurosurgical Sciences. 2018. doi: 10.23736/S0390-5616.18.04466-1
  21. Day J.D., Transsulcal Parafascicular Surgery Using BrainPath for Subcortical Lesions. Clinical Neurosurgery. 2017; 64(1):151–156. doi:10.1093/neuros/nyx324