Barotrauma-Induced Pneumocephalus Experienced by a High Risk Patient after Commercial Air Travel

Abstract

A 49-year-old female with a history of several neurosurgical and otolaryngologic procedures for occipital meningioma and cerebrospinal fluid leaks was diagnosed with pneumocephalus after a one hour flight on a domestic jet airliner. Despite multiple operations, the air appeared to enter the cranium through a weak portion of the skull base due to the low atmospheric pressure in the cabin. The intracranial air was absorbed with conservative management. The patient was recommended not to fly before a definite diagnostic work up and a sealing procedure for the cerebrospinal fluid leak site had been performed. Recent advances in aviation technology have enabled many people to travel by air, including individuals with medical conditions. Low cabin pressure is not dangerous to healthy individuals; however, practicing consultant neurosurgeons should understand the cabin environment and prepare high risk patients for safe air travel.

Review of the management of pneumocephalus

“…Although it is difficult to make one guideline to apply to all cases, the concern for possible problems during air travel could lead to a consensus among consultant neurosurgeons. [ 11 ]…”

Pneumocephalus and Facial Droop on an Airplane: A Case Report

“…1 , 2 PNC after air travel has been described in isolated case reports where, again, patients had a history of neurosurgical intervention. 3 , 4 Barotrauma as the etiology of spontaneous PNC is very rare and has been described in scuba diving-related pressure changes. 5 These cases were identified through a literature search using the keywords “pneumocephalus,” “pneumocranium”, “pneumatocephalus,” or “intracranial pneumatocele” in PubMed and Cochrane Library databases, and are all published in neurosurgical literature, as were the vast majority of PNC case reports identified in our search.…”

A prospective randomized clinical trial to evaluate the impact of intraoperative ventilation with high oxygen content on the extent of postoperative pneumocephalus in patients undergoing craniotomies

“…Changes in airplane cabin atmospheric pressure may significantly affect the extension of pneumocephalus by increasing intracranial air volume. 13 Even though no neurological deterioration has been reported under these conditions, the Aerospace Medical Association recommends performing a lateral skull radiograph or a CT scan before traveling in order to rule out the presence of postoperative intracranial air. If images are unavailable, patients are advised to hold any air transportation for at least 7 days after the surgery.…”