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.

Keywords: Air travel; Cerebrospinal fluid leak; Pneumocephalus.

Fig. 1

Initial brain computed tomography shows extensive air within the subarachnoid space of the basal cistern (A), bilateral lateral and third ventricle, and in the intraparenchymal portion of the left frontal lobe (B).