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.

• Klíčová slova
• adenomas, computational fluid dynamics (cfd), computed tomography (ct), nasal cavity, pituitary tumour,
• Publikační typ
• časopisecké články MeSH

OBJECTIVE: This study was designed to evaluate the possibility of predicting the minimum size of septal resection for safe tumor extraction in transnasal paraseptal pituitary adenoma resection from preoperative computed tomography scans. METHODS: A retrospective CT scan analysis was performed on 20 patients who underwent endoscopic pituitary surgery at the University Hospital in Ostrava. Virtual insertion of the straight instrument into the sphenoid cavity was simulated using a CT scan. The minimum septal resection size was predicted and compared to various diameters in the nasal cavity. The results were then compared with cadaveric dissections, in which septal resections were performed at 1 cm and 2 cm distances from the anterior sphenoid wall. The association between cadaver dissections and CT scan results was studied. RESULTS: A total of 20 patients who underwent endoscopic transnasal surgery for pituitary adenoma between the years 2020 and 2021 were enrolled in the study. The mean virtual posterior septal size resection needed to reach the medial edge of the ICA with the straight instrument, without infracturing the nasal septum, was 13.2 mm. In cadavers with a 1 cm posterior septal resection, the medial edge of the ICA was reached with the straight instrument. In 2 cm resections, it was possible to reach beyond the lateral edge of the ICA. CONCLUSION: There is no significant correlation between the minimum septal size resection and measured diameters in the nasal cavity. According to our study, a 1 cm resection is sufficient for a non-extended pituitary tumor extraction. More extensive septal resections allow for better maneuverability and overview in the surgical field.

• Klíčová slova
• binostril approach, endoscopic transnasal approach, pituitary adenoma, septal resection, transsphenoidal approach,
• MeSH
• adenom * diagnostické zobrazování   chirurgie   patologie   MeSH
• endoskopie metody   MeSH
• lidé MeSH
• nádory hypofýzy * diagnostické zobrazování   chirurgie   patologie   MeSH
• nosní dutina diagnostické zobrazování   chirurgie   patologie   MeSH
• počítačová rentgenová tomografie MeSH
• retrospektivní studie MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH

INTRODUCTION: In recent years, the evaluation of potential events related to olfactory events (OERPs) and trigeminal events (TERPs) has become increasingly important in the diagnosis of olfactory disorders. This technique is increasingly used in basic research and clinical practice to evaluate people suffering from olfactory disorders. PURPOSE OF THE STUDY: In a pilot project of the first investigations of OERPs and TERPs in the Czech Republic, we analyse the event-related potentials of the data of normosmic participants. METHODS: In the prospective study, 21 normosmic participants were enrolled for a 2-year period (5/2021-5/2023). OERPs/TERPs were recorded at the scalp vertex (electrode Pz/Cz). Odourants 2-phenylethanol/CO2 were used to selectively activate Nervus olfactorius/ Nervus trigeminus. Brain responses to olfactory/trigeminal stimuli (EEG) were recorded in 21/18 normosmic subjects. RESULTS: In the statistical analysis of the olfactory interval N1-P2 (age, gender), we found no statistically significant differences. In the statistical analysis of the trigeminal interval N1-P2 (age, gender) we found statistically significant differences in amplitude by gender (male amplitudes were higher than female amplitudes, p = 0.006). CONCLUSION: Our pilot data can function very well as an internal guide for ongoing and future olfactory research studies. Evaluation of the presence of OERPs appears to be an important parameter for the evaluation of olfactory disorders. The absence of OERPs is a strong indicator of the presence of olfactory dysfunction.

• Klíčová slova
• Evaluation of smell, Objective olfactometry, Odourants, Olfactory event-related potentials, Trigeminal event-related potentials,
• MeSH
• čich * fyziologie   MeSH
• evokované potenciály fyziologie   MeSH
• lidé MeSH
• pilotní projekty MeSH
• poruchy čichu * diagnóza   MeSH
• prospektivní studie MeSH
• Check Tag
• lidé MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• Geografické názvy
• Česká republika MeSH

The subjective and demanding nature of olfactory testing means that it is often neglected in clinic despite loss of smell leading to significant limitations in everyday life. The list of diseases associated with loss of olfaction far exceeds the field of otorhinolaryngology and can also be seen in neurodegenerative disorders. Knowledge of possible clinical testing is essential to determine a proper differential diagnosis for the loss of olfactory sense. Causes of olfactory impairment can be divided into either failure in transferring odour to the organ of perception or damage to the olfactory pathway structure itself. Examination should therefore include methods evaluating cross-sectional area and patency of the nasal cavity as well as subjective or objective assessment of olfactory function. In this report we summarize several articles, studies, and our own experiences to provide a comprehensive review of their current clinical usage including their benefits, limitations, and possible outcomes. We also discuss the mechanism of olfaction step by step to provide a full understanding of the possible errors depending on the localization in the pathway and the methods designed for their detection. We discuss the correlation of the microbiome in nasal polyposis and chronic rhinitis with olfactory impairment using objective olfactometry. The topic of objective olfactometry and the examination of olfactory event-related potentials (OERP) is commented upon in detail.

• Klíčová slova
• anosmia, hyposmia, objective olfactometry, odourants, olfactory event-related potentials, olfactory system, parosmia,
• Publikační typ
• časopisecké články MeSH
• přehledy MeSH

Pituitary adenoma surgery has evolved rapidly in recent decades, changing clinical practice markedly and raising new challenges. There is no current consensus or guidelines for perioperative care that includes possible complication management. This study aims to determine current practice across European neurosurgical centres. We created a list of eligible departments performing pituitary adenoma surgery based on cooperation with EANS, national neurosurgical societies, and personal communication with local neurosurgeons. We contacted the chairpersons from each department and asked them (or another responsible neurosurgeon) to fill out the survey. The survey consisted of 58 questions. For further analysis, departments were divided into subgroups: "academic"/ "non-academic centre", "high-volume"/"low-volume", "mainly endoscopic"/ "mainly microscopic"/ "mixed practise", and by geographical regions. Data from 254 departments from 34 countries were obtained. The average time to complete the survey was 18 min. Notably, the endoscopic approach is the predominant surgical approach in Europe, used in 56.8% of the centres. In routine cases without intraoperative cerebrospinal fluid leak, high-volume centres are less pedantic with sellar closure when compared with low-volume centres (p < 0.001). On the other hand, when a postoperative cerebrospinal fluid leak occurs, high-volume centres are more active and indicate early reoperation (p = 0.013). Less than 15% of the participating centres perform early postoperative MRI scans. Marked variation was noted among different groups of respondents and some contentious issues are discussed. Such information can encourage useful debate about the reasons for the variations seen and perhaps help develop standardised protocols to improve patient outcomes. A future research focus is to compare European results with other regions.

• Klíčová slova
• Endocrinology, Neurosurgery, Pituitary adenoma, Survey,
• MeSH
• adenom * chirurgie   MeSH
• endoskopie MeSH
• lidé MeSH
• nádory hypofýzy * chirurgie   MeSH
• průzkumy a dotazníky MeSH
• retrospektivní studie MeSH
• únik mozkomíšního moku MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH

Endoscopic endonasal approach uses the nasal cavity and paranasal sinuses to access the cranial base and may be a source of post-surgical morbidity in many patients with a sellar tumour. The objective of the presented study was to evaluate sinonasal quality of life and assess the effect of chosen reconstruction of the cranial base on the final condition. 65 patients, 33 male and 32 female who underwent an endoscopic endonasal surgery due to sellar expansion, were included into this prospective study. Sinonasal quality of life was evaluated using the Sinonasal Outcome Test-22 (SNOT-22) questionnaire before the surgery and six months after the surgery. Sinonasal quality of life was evaluated for the total cohort of patients and for patients after reconstruction (fascia lata, muscle) and without reconstruction. The minimum follow-up period was one year. There was no significant difference between the score (SNOT-22) before the surgery (average 14.4 points) and after the surgery (average 17.5 points), p = 0.067 in the whole cohort. Statistically significant differences were found in the following items-the need to blow nose, nasal congestion, loss of smell and taste, and thick discharge from the nose. The comparison of subgroups with and without the reconstruction yielded statistically significant differences in favour of patients with reconstruction in the following items-lack of high-quality sleep and feeling exhaustion. The endoscopic endonasal approach in patients with a sellar tumour is a gentle method with minimal effects on sinonasal quality of life over a period longer than six months. The most common complaints are the need to blow nose, nasal congestion, loss of smell and taste, and thick discharge from the nose. Cranial base reconstruction using the muscle and fascia lata seems to be a potential factor positively influencing sinonasal quality of life.

• MeSH
• dospělí MeSH
• endoskopie škodlivé účinky   MeSH
• kvalita života * MeSH
• lidé středního věku MeSH
• lidé MeSH
• mladý dospělý MeSH
• nádory hypofýzy patologie   chirurgie   MeSH
• následné studie MeSH
• nemoci nosu etiologie   patologie   MeSH
• nosní dutina patologie   chirurgie   MeSH
• paranazální dutiny patologie   chirurgie   MeSH
• prognóza MeSH
• prospektivní studie MeSH
• sella turcica patologie   chirurgie   MeSH
• senioři MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mladý dospělý MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH