Modeling alterations in sinonasal physiology after skull base surgery.

Area of Science:

• Computational fluid dynamics (CFD) applied to virtual surgical models.
• Analysis of sinonasal physiology and airflow dynamics.

Background:

• Endonasal endoscopic skull base surgery (EESBS) significantly alters intranasal anatomy.
• Procedures like posterior septectomy (PS) and middle turbinate resection (MTR) are common for tumor access.
• Sinonasal physiological changes post-EESBS are not well understood.

Purpose of the Study:

• To assess sinonasal physiological changes after virtual EESBS.
• To evaluate the impact of different surgical techniques on airflow patterns.
• To investigate the influence of patient-specific anatomy on surgical outcomes.

Main Methods:

• Created 3D sinonasal models from CT scans of three subjects with varying septal deviation (SD).
• Performed virtual surgeries including endoscopic transsphenoidal approach (ETSA) with different degrees of PS and MTR.
• Utilized computational fluid dynamics (CFD) to simulate airflow in pre- and post-virtual surgery models.

Main Results:

• Increased nasal airflow correlated with the amount of resected tissue.
• Middle turbinate resection (MTR) altered unilateral airflow allocation, with varied effects based on septal deviation (SD).
• MTR hindered olfactory mucosa airflow interactions in subjects with SD.

Conclusions:

• CFD simulations effectively detect airflow pattern changes in virtual nasal models.
• Individual patient anatomy significantly influences the magnitude and direction of post-EESBS airflow changes.
• CFD holds potential as a clinical tool for surgical planning and optimizing patient outcomes.