Postoperative Recommendations for Commercial Air Travel After Neurosurgical Intervention

INTRODUCTION: Existing recommendations on return-to-flight following neurosurgery are broad, vary by organization, and have limited supporting evidence. Air travel after neurosurgery may increase the risk of medical events, raising the need for focused flight-clearance guidelines. METHODS: Attending neurosurgeons were surveyed using case-based scenarios with flight-clearance timelines and preflight imaging questions. RESULTS: Recommended flight-clearance times varied by procedure: tumor craniotomy, [mean (SD)] 2.4 (2.2) wk; subdural hematoma craniotomy, 3.8 (3.5) wk; uncomplicated transparanasal approach, 4.4 (3.7) wk; transparanasal approach with cerebrospinal fluid leak repair, 6.0 (4.3) wk; craniectomy with bone flap off, 2.7 (3.0) wk; and ventriculoperitoneal shunt, 2.0 (1.6) wk. Operation type influenced return-to-flight timeline recommendations. Presence of pneumocephalus was rated the most important medical clearance factor, and the proportion of neurosurgeons recommending preflight imaging studies varied between different operations: 46% for tumor craniotomy, 79% for subdural hematoma craniotomy, 43% for transparanasal approach, 46% for craniectomy, and 38% for ventriculoperitoneal shunt. Clearance depended strongly on pneumocephalus volume: >50 mL (0% of surgeons cleared immediately; mean 5.1 (4.5) wk), ∼30 mL (14% of surgeons cleared immediately; 3.6 (4.2) wk), and