PURPOSE: Pituitary adenoma, a relatively common intracranial tumor, is often treated surgically through the nasal cavity, which alters its anatomy. This study aims to determine the severity of these changes in airflow and flow distribution within the nasal cavity, focusing on the anterior nasal region's role in airflow redistribution. Computational fluid dynamics (CFD) was employed to analyze these changes before and after surgery. METHODS: Data from four patients of the Department of Neurosurgery and Neuro-oncology of the Military University Hospital, Prague, were analyzed using CFD simulations in Ansys Fluent 2021 R1. Computed tomography (CT) scans were used to model the nasal cavities pre- and post-surgery, creating polyhedral meshes of 1.8 million cells before surgery and 2.2 million cells after surgery. The k-ε turbulent model was applied to compute flow fields, providing consistent results across patients. RESULTS: The surgery increased the nasal cavity volume, primarily due to the endonasal transsphenoidal approach. Cross-sectional areas, particularly in the middle nasal meatus, were enlarged, reducing airflow velocity without altering total volume flow. Most airflow was redistributed through the middle nasal meatus, while flow in peripheral regions decreased. The anterior part of the nasal cavity was identified as having the most significant influence on airflow redistribution. CONCLUSION: Surgery impacts nasal anatomy and airflow dynamics significantly, particularly in the anterior part of the nasal cavity. These findings emphasize the need for surgical precision to minimize unintended shifts in airflow patterns. Further studies are recommended to validate these observations.

1st Faculty of Medicine Department of Neurosurgery and Neurooncology Charles University and Military University Hospital Prague CZE

Department of Otorhinolaryngology University of Dresden Medical School Dresden DEU

Faculty of Mechanical Engineering Department of Fluid Dynamics and Thermodynamics Czech Technical University Prague Prague CZE

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Perioperative nasal and paranasal sinus considerations in transsphenoidal surgery for pituitary disease. Caulley L, Uppaluri R, Dunn IF. Br J Neurosurg. 2020;34:246–252. PubMed

Olfactory function in patients after transsphenoidal surgery for pituitary adenomas-a short review. Majovsky M, Astl J, Kovar D, Masopust V, Benes V, Netuka D. Neurosurg Rev. 2019;42:395–401. PubMed

Olfactory disorders and quality of life--an updated review. Croy I, Nordin S, Hummel T. Chem Senses. 2014;39:185–194. PubMed

Depression, olfaction, and quality of life: a mutual relationship. Rochet M, El-Hage W, Richa S, Kazour F, Atanasova B. Brain Sci. 2018;8 PubMed PMC

Olfaction as a marker for depression. Croy I, Hummel T. J Neurol. 2017;264:631–638. PubMed

Olfactory changes at threshold and suprathreshold levels following septoplasty with partial inferior turbinectomy. Damm M, Eckel HE, Jungehülsing M, Hummel T. Ann Otol Rhinol Laryngol. 2003;112:91–97. PubMed

Impact of middle turbinectomy on airflow to the olfactory cleft: a computational fluid dynamics study. Alam S, Li C, Bradburn KH, Zhao K, Lee TS. Am J Rhinol Allergy. 2019;33:263–268. PubMed PMC

Computational fluid dynamics as surgical planning tool: a pilot study on middle turbinate resection. Zhao K, Malhotra P, Rosen D, Dalton P, Pribitkin EA. Anat Rec (Hoboken) 2014;297:2187–2195. PubMed PMC

Evaluation of nasal function after endoscopic endonasal surgery for pituitary adenoma: a computational fluid dynamics study. Lou M, Zhang L, Wang S, et al. Comput Methods Biomech Biomed Engin. 2022;25:1449–1458. PubMed

Computational fluid dynamics after endoscopic endonasal skull base surgery-possible empty nose syndrome in the context of middle turbinate resection. Maza G, Li C, Krebs JP, Otto BA, Farag AA, Carrau RL, Zhao K. Int Forum Allergy Rhinol. 2019;9:204–211. PubMed PMC

Modeling alterations in sinonasal physiology after skull base surgery. Frank-Ito DO, Sajisevi M, Solares CA, Jang DW. Am J Rhinol Allergy. 2015;29:145–150. PubMed

Impact of endoscopic craniofacial resection on simulated nasal airflow and heat transport. Tracy LF, Basu S, Shah PV, Frank-Ito DO, Das S, Zanation AM, Kimbell JS. Int Forum Allergy Rhinol. 2019;9:900–909. PubMed PMC

Is nasal airflow disrupted after endoscopic skull base surgery? A short review. Májovský M, Trnka F, Schmirlerová H, Betka J, Hyhlík T, Netuka D. Neurosurg Rev. 2022;45:3641–3646. PubMed

Relation between CT scan findings and human sense of smell. Hong S, Leopold D, Oliverio P, et al. Otolaryngol Head Neck Surg. 1998;118(2):183–186. PubMed

Preparation of a real model of nasal cavities from computed tomography for numerical simulation. Trnka F, Schmirlerová H, Májovský M, et al. MATEC Web of Conferences. 2022;369

Mylavarapu G, Mihaescu M, Gutmark E, et al. 47th AIAA Aerospace Sciences Meeting including The New Horizons Forum and Aerospace Exposition. Orlando, FL: 2009. Importance of paranasal sinuses in computational modeling of nasal airflow.

Effects of paranasal sinus ostia and volume on acoustic rhinometry measurements: a model study. Cakmak O, Celik H, Cankurtaran M, Buyuklu F, Ozgirgin N, Ozluoglu LN. J Appl Physiol (1985) 2003;94:1527–1535. PubMed

Effects of surface smoothness on inertial particle deposition in human nasal models. Schroeter JD, Garcia GJ, Kimbell JS. J Aerosol Sci. 2011;42:52–63. PubMed PMC

Examining the impact of inlet shape on nasal cavity flow field: a computational investigation. Trnka F, Schmirlerová H, Májovský M, et al. MATEC Web of Conferences. 2023;383

Mösges R. Nasal physiology and pathophysiology of nasal disorders. Berlin Heidelberg: Springer-Verlag; 2013. Computational Fluid Dynamics of the Nasal Cavity; pp. 247–255.

CFD analysis of the flow structure in a monkey upper airway validated by PIV experiments. Phuong NL, Quang TV, Khoa ND, Kim JW, Ito K. Respir Physiol Neurobiol. 2020;271:103304. PubMed

Investigation of flow pattern in upper human airway including oral and nasal inhalation by PIV and CFD. Phuong NL, Ito K. Build Environ. 2015;94:504–515.

Nasal cavity airflow: comparing laser doppler anemometry and computational fluid dynamic simulations. Berger M, Pillei M, Mehrle A, et al. Respir Physiol Neurobiol. 2021;283:103533. PubMed

Assessment of PIV performance in validating CFD models from nasal cavity CBCT scans. Ormiskangas J, Valtonen O, Kivekäs I, et al. Respir Physiol Neurobiol. 2020;282:103508. PubMed

Zuber M, Ahmad KA, Abdullah MZ, et al. 2012 International Conference on Biomedical Engineering (ICoBE) 2012. Computational fluid dynamics study of middle turbinectomy; pp. 338–341.

Olfactory results of endoscopic endonasal surgery for pituitary adenoma: a prospective study of 143 patients. Netuka D, Masopust V, Fundová P, Astl J, Školoudík D, Májovský M, Beneš V. World Neurosurg. 2019;129:0–14. PubMed

Computational fluid dynamics simulation of wall shear stress and pressure distribution from a neti pot during nasal saline irrigation. Salati H, Bartley J, White DE. J Med Biol Eng. 2021;41(2):175–184.

Surface mapping for visualization of wall stresses during inhalation in a human nasal cavity. Inthavong K, Shang Y, Tu J. Respir Physiol Neurobiol. 2014;190:54–61. PubMed

Effects of partial middle turbinectomy with varying resection volume and location on nasal functions and airflow characteristics by CFD. Lee KB, Jeon YS, Chung SK, Kim SK. Comput Biol Med. 2016;77:214–221. PubMed