Creating Virtual Surgery Targets & Methods to Improve Outcomes of Nasal Surgery

描述(由申请人提供)：在美国，每年有超过34万人接受手术矫正鼻道阻塞(NAO)。大约23-37%的此类手术无法纠正患者的症状。鼻外科手术的高无效率在很大程度上是由于缺乏 可以可靠地量化鼻功能和预测手术结果的工具。量化鼻功能的计算方法显示出巨大的前景，但关于哪些生物物理变量最能预测症状变化，什么范围的目标值是标准的，以及如何最好地制作一种虚拟手术工具，外科医生可以用来为每个人制定“正确的”手术计划，缺乏信息。在过去的四年里，我们探索了计算流体动力学(CFD)建模作为该工具的潜在基础。我们创建了手术前和手术后NAO患者调查的数据库，基于CT扫描的CFD模型，并计算了鼻部手术结果的客观衡量标准。我们发现，某些CFD生物物理变量-鼻腔阻力、热流密度和单侧气流-可以区分手术前和手术后状态，并与患者报告的症状关联最好。我们还发现，试图复制实际手术的虚拟手术CFD模型产生的基于CFD的测量结果与基于实际手术模型的测量结果相似，从而初步验证了虚拟手术规划是可行的。我们的长期目标是开发一种临床医生普遍可用的鼻部虚拟手术工具，以改善患者的预后。这个目标将以循序渐进的方式实现。第一步，确定跟踪患者症状的生物物理变量，由我们先前的研究完成。第二步，也就是本次更新建议的目标，是确定这些变量作为手术目标的规范值，开发优化虚拟鼻手术的方法，并探索虚拟手术建模对手术决策的影响。未来的步骤将包括为临床医生创建用户友好的虚拟手术软件，并进行前瞻性临床试验，以确定虚拟计划指导的手术是否比当前的护理标准更成功。我们的中心假设是，通过使用虚拟手术工具来设计个性化的鼻部解剖结构，通过针对正确的手术类型和数量来优化鼻功能，可以提高目前NAO手术的护理标准。

DESCRIPTION (provided by applicant): Over 340,000 people in the US have surgery to correct nasal airway obstruction (NAO) annually. Approximately 23-37% of these surgeries fail to correct patients' symptoms. The high inefficacy rate of nasal surgery is largely due to the lack of tools that can reliably quantify nasal function and predict surgical outcomes. Computational methods for quantifying nasal function show significant promise, but information is lacking on which biophysical variables best predict symptom changes, what ranges of objective values are normative, and how best to make a virtual surgery tool that surgeons can use to develop the "correct" surgical plan for each individual. During the past four years, we explored computational fluid dynamics (CFD) modeling as a potential basis for this tool. We created pre- and post-surgery databases of NAO patient surveys, computed tomography (CT) scan-based CFD models, and computed objective measures of nasal surgical outcomes. We found that certain CFD biophysical variables - nasal resistance, heat flux, and unilateral airflow - discriminated between pre- and post-surgery states and correlated best with patient-reported symptoms. We also found that virtual surgery CFD models that attempted to replicate the actual surgery produced CFD-based measurements similar to those based on actual surgery models, thus providing the initial validation that virtual surgery planning is feasible. Our long-term goal is o develop a nasal virtual surgery tool that will be universally accessible to clinicians to improve patient outcomes. This goal will be accomplished in a stepwise fashion. The first step, identifying biophysical variables that track with patient symptoms, was accomplished by our prior study. The second step, which is the goal of this proposal for renewal, is to determine normative values for these variables as targets for surgery, develop methods to optimize virtual nasal surgery, and to explore the impact of virtual surgery modeling on surgeon decision-making. Future steps will include the creation of user-friendly virtual surgery software for the clinician and a prospective clinical trial to determine if virtual planning-guided surgeries are moe successful than the current standard of care. Our central hypothesis is that the current standard of care for NAO surgery can be improved by using a virtual surgery tool to design individualized nasal anatomy that optimizes nasal function by targeting the correct type and amount of surgery.