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

Area3

Area1

Area4

Area2

Area 4 Area 3 Area 2 Area 1

central core

peritumoral zone

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.