DOI QR코드

DOI QR Code

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

  • Huh, Jisoon (Department of Neurosurgery, Jeju National University Hospital, Jeju National University School of Medicine)
  • Received : 2013.04.02
  • Accepted : 2013.08.05
  • Published : 2013.08.28

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

References

  1. Aerospace Medical Association Medical Guidelines Task Force : Medical Guidelines for Airline Travel, 2nd ed. Aviat Space Environ Med 74 (5 Suppl) : A1-A19, 2003
  2. Amato-Watkins A, Rao VM, Leach P : Air travel after intracranial surgery : a survey of advice given to patients by consultant neurosurgeons in the UK. Br J Neurosurg 27 : 9-11, 2013 https://doi.org/10.3109/02688697.2012.716176
  3. Andersson N, Grip H, Lindvall P, Koskinen LO, Brändström H, Malm J, et al. : Air transport of patients with intracranial air : computer model of pressure effects. Aviat Space Environ Med 74 : 138-144, 2003
  4. Beda RD, Khot SP, Manning T, Walker M. Airhead : intraparenchymal pneumocephalus after commercial air travel. Surg Neurol 68 : 648-689, 2007 https://doi.org/10.1016/j.surneu.2007.08.026
  5. Canavan L, Osborn RE : Dural sinus air without head trauma or surgery : CT demonstration. J Comput Assist Tomogr 15 : 526-527, 1991
  6. Chan YP, Yau CY, Lewis RR, Kinirons MT : Acute confusion secondary to pneumocephalus in an elderly patient. Age Ageing 29 : 365-367, 2000 https://doi.org/10.1093/ageing/29.4.365
  7. Donovan DJ, Iskandar JI, Dunn CJ, King JA : Aeromedical evacuation of patients with pneumocephalus : outcomes in 21 cases. Aviat Space Environ Med 79 : 30-35, 2008 https://doi.org/10.3357/ASEM.1893.2008
  8. Guerado E, Peña D : Pneumoencephalomeningitis secondary to infected lumbar arthrodesis with a fistula : a case report. Acta Orthop Belg 67 : 300-303, 2001
  9. Javan R, Duszak R Jr, Eisenberg AD, Eggers FM : Spontaneous pneumocephalus after commercial air travel complicated by meningitis. Aviat Space Environ Med 82 : 1153-1156, 2011 https://doi.org/10.3357/ASEM.3100.2011
  10. Jensen MB, Adams HP : Pneumocephalus after air travel. Neurology 63 : 400-401, 2004 https://doi.org/10.1212/01.WNL.0000130264.66211.74
  11. Mahabir RC, Szymczak A, Sutherland GR : Intracerebral pneumatocele presenting after air travel. J Neurosurg 101 : 340-342, 2004 https://doi.org/10.3171/jns.2004.101.2.0340
  12. Markham JW : The clinical features of pneumocephalus based upon a survey of 284 cases with report of 11 additional cases. Acta Neurochir (Wien) 16 : 1-78, 1967 https://doi.org/10.1007/BF01401900
  13. Seth R, Mir S, Dhir JS, Cheeseman C, Singh J : Fitness to fly post craniotomy--a survey of medical advice from long-haul airline carriers. Br J Neurosurg 23 : 184-187, 2009 https://doi.org/10.1080/02688690802669351
  14. Zeba I, Barkovic I, Knezevic S, Lender DM, Bralic M, Bulat-Kardum L : Pneumocephalus after an uneventful scuba dive. Aviat Space Environ Med 81 : 511-513, 2010 https://doi.org/10.3357/ASEM.2686.2010

Cited by

  1. Review of the management of pneumocephalus vol.6, pp.None, 2013, https://doi.org/10.4103/2152-7806.166195
  2. Pneumocephalus Following Air Travel in a Patient With Preexisting Facial Fractures and Dural Tears vol.27, pp.7, 2016, https://doi.org/10.1097/scs.0000000000002919
  3. 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 vol.33, pp.2, 2013, https://doi.org/10.1080/02688697.2018.1562031
  4. SCUBA Medicine for Otolaryngologists: Part II. Diagnostic, Treatment, and Dive Fitness Recommendations vol.130, pp.1, 2013, https://doi.org/10.1002/lary.27874
  5. Pneumocephalus and Facial Droop on an Airplane: A Case Report vol.4, pp.3, 2020, https://doi.org/10.5811/cpcem.2020.4.46799