Return-to-fly after flow diversion for unruptured paraclinoid aneurysms in military pilots

Objective: Advances in neuroimaging have increased detection of unruptured paraclinoid aneurysms among military pilots, a population subjected to unique environmental stressors that may elevate rupture risk. However, optimal management remains clinically uncertain. This study introduced the procedural safety, occlusion efficacy, and flight requalification outcomes following flow diversion (FD) treatment in this cohort. Methods: A retrospective review was conducted on military pilots who underwent FD treatment for unruptured paraclinoid aneurysms between 2019 and 2024. Demographic, aneurysm, and treatment data were collected. Outcomes included procedural success, occlusion status (assessed by the Modified O'Kelly-Marotta (OKM) scale), and flight requalification status. Results: Four pilots with five aneurysms underwent successful FD implantation. All achieved complete aneurysm occlusion (OKM-D) at 12-month follow-up without thromboembolic or hemorrhagic complications. Two high-performance fighter pilots initially received dual-seat restrictions before full clearance; one helicopter pilot and one transport aircraft pilot were cleared directly. All pilots successfully returned to flight duties, accumulating 80-200 safe flight hours post-treatment. Conclusion: FD treatment for unruptured paraclinoid aneurysms in military pilots is safe and effective, facilitating timely return to flight duty with appropriate aeromedical evaluation.