{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,17]],"date-time":"2026-08-17T15:26:27Z","timestamp":1786980387725,"version":"build-2736575974"},"reference-count":20,"publisher":"Springer Science and Business Media LLC","issue":"9","license":[{"start":{"date-parts":[[2022,7,6]],"date-time":"2022-07-06T00:00:00Z","timestamp":1657065600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2022,7,6]],"date-time":"2022-07-06T00:00:00Z","timestamp":1657065600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/501100006447","name":"University of Zurich","doi-asserted-by":"crossref","id":[{"id":"10.13039\/501100006447","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Acta Neurochir"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Concerns arise when patients with pneumocephalus engage in air travel. How hypobaric cabin pressure affects intracranial air is largely unclear. A widespread concern is that the intracranial volume could relevantly expand during flight and lead to elevated intracranial pressure. The aim of this systematic review was to identify and summarise models and case reports with confirmed pre-flight pneumocephalus.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>The terms (pneumocephalus OR intracranial air) AND (flying OR fly OR travel OR air transport OR aircraft) were used to search the database PubMed on 30 November 2021. This search returned 144 results. To be included, a paper needed to fulfil each of the following criteria: (i) peer-reviewed publication of case reports, surveys, simulations or laboratory experiments that focussed on air travel with pre-existing pneumocephalus; (ii) available in full text.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Thirteen studies met the inclusion criteria after title or abstract screening. We additionally identified five more articles when reviewing the references. A notion that repeatedly surfaced is that any air contained within the neurocranium increases in volume at higher altitude, much like any extracranial gas, potentially resulting in tension pneumocephalus or increased intracranial pressure.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Discussion<\/jats:title>\n                    <jats:p>Relatively conservative thresholds for patients flying with pneumocephalus are suggested based on models where the intracranial air equilibrates with cabin pressure, although intracranial air in a confined space would be surrounded by the intracranial pressure. There is a discrepancy between the models and case presentations in that we found no reports of permanent or transient decompensation secondary to a pre-existing pneumocephalus during air travel. Nevertheless, the quality of examination varies and clinicians might tend to refrain from reporting adverse events. We identified a persistent extracranial to intracranial fistulous process in multiple cases with newly diagnosed pneumocephalus after flight. Finally, we summarised management principles to avoid complications from pneumocephalus during air travel and argue that a patient-specific understanding of the pathophysiology and time course of the pneumocephalus are potentially more important than its volume.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s00701-022-05297-5","type":"journal-article","created":{"date-parts":[[2022,7,6]],"date-time":"2022-07-06T13:03:10Z","timestamp":1657112590000},"page":"2395-2400","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":10,"title":["Air travel with pneumocephalus: a systematic review"],"prefix":"10.1007","volume":"164","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1026-5753","authenticated-orcid":false,"given":"Oliver","family":"Bichsel","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Annalisa","family":"Hauck","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Markus","family":"Oertel","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2022,7,6]]},"reference":[{"issue":"1","key":"5297_CR1","doi-asserted-by":"publisher","first-page":"9","DOI":"10.3109\/02688697.2012.716176","volume":"27","author":"A Amato-Watkins","year":"2013","unstructured":"Amato-Watkins A, Rao VM, Leach P (2013) Air travel after intracranial surgery: a survey of advice given to patients by consultant neurosurgeons in the UK. Br J Neurosurg 27(1):9\u201311","journal-title":"Br J Neurosurg"},{"issue":"2","key":"5297_CR2","first-page":"138","volume":"74","author":"N Andersson","year":"2003","unstructured":"Andersson N, Grip H, Lindvall P, Koskinen LO, Br\u00e4ndstr\u00f6m H, Malm J, Eklund A (2003) Air transport of patients with intracranial air: computer model of pressure effects. Aviat Space Env Med 74(2):138\u2013144","journal-title":"Aviat Space Env Med"},{"issue":"1","key":"5297_CR3","doi-asserted-by":"publisher","first-page":"71","DOI":"10.1016\/j.amj.2017.09.011","volume":"37","author":"E Augustin","year":"2018","unstructured":"Augustin E, Karsy M, Bryan J, Guan J, Schmidt RH (2018) Air transport of a patient with impending cerebral herniation from tension pneumocephalus. Air Med J 37(1):71\u201373","journal-title":"Air Med J"},{"issue":"6","key":"5297_CR4","doi-asserted-by":"publisher","first-page":"648","DOI":"10.1016\/j.surneu.2007.08.026","volume":"68","author":"RD Beda","year":"2007","unstructured":"Beda RD, Khot SP, Manning T, Walker M (2007) Airhead: intraparenchymal pneumocephalus after commercial air travel. Surg Neurol 68(6):648\u2013649","journal-title":"Surg Neurol"},{"issue":"1","key":"5297_CR5","doi-asserted-by":"publisher","first-page":"50","DOI":"10.1186\/s13049-017-0394-9","volume":"25","author":"H Br\u00e4ndstr\u00f6m","year":"2017","unstructured":"Br\u00e4ndstr\u00f6m H, Sundelin A, Hoseason D, Sundstr\u00f6m N, Birgander R, Johansson G, Wins\u00f6 O, Koskinen L-O, Haney M (2017) Risk for intracranial pressure increase related to enclosed air in post-craniotomy patients during air ambulance transport: a retrospective cohort study with simulation. Scand J Trauma Resusc Emerg Med 25(1):50","journal-title":"Scand J Trauma Resusc Emerg Med"},{"issue":"7","key":"5297_CR6","doi-asserted-by":"publisher","first-page":"1774","DOI":"10.1097\/SCS.0000000000002919","volume":"27","author":"KM Chue","year":"2016","unstructured":"Chue KM, Lim TC, Lim J, Yap YL, Ong WC (2016) Pneumocephalus following air travel in a patient with preexisting facial fractures and dural tears. J Craniofac Surg 27(7):1774\u20131776","journal-title":"J Craniofac Surg"},{"key":"5297_CR7","doi-asserted-by":"crossref","unstructured":"Dabdoub CB, Salas G, Silveira E d. o. N, Dabdoub CF (2015) Review of the management of pneumocephalus. Surg Neurol Int 6:155","DOI":"10.4103\/2152-7806.166195"},{"issue":"2","key":"5297_CR8","doi-asserted-by":"publisher","first-page":"442","DOI":"10.1097\/00000542-199602000-00024","volume":"84","author":"F Dexter","year":"1996","unstructured":"Dexter F, Reasoner DK (1996) Theoretical assessment of normobaric oxygen therapy to treat pneumocephalus. Anesthesiology 84(2):442\u2013447","journal-title":"Anesthesiology"},{"issue":"1","key":"5297_CR9","doi-asserted-by":"publisher","first-page":"30","DOI":"10.3357\/ASEM.1893.2008","volume":"79","author":"DJ Donovan","year":"2008","unstructured":"Donovan DJ, Iskandar JI, Dunn CJ, King JA (2008) Aeromedical evacuation of patients with pneumocephalus: outcomes in 21 cases. Aviat Space Env Med 79(1):30\u201335","journal-title":"Aviat Space Env Med"},{"issue":"5","key":"5297_CR10","doi-asserted-by":"publisher","first-page":"926","DOI":"10.3171\/JNS\/2008\/108\/5\/0926","volume":"108","author":"PA Gore","year":"2008","unstructured":"Gore PA, Maan H, Chang S, Pitt AM, Spetzler RF, Nakaji P (2008) Normobaric oxygen therapy strategies in the treatment of postcraniotomy pneumocephalus. J Neurosurg 108(5):926\u2013929","journal-title":"J Neurosurg"},{"issue":"7","key":"5297_CR11","doi-asserted-by":"publisher","first-page":"577","DOI":"10.7205\/MILMED.170.7.577","volume":"170","author":"E Helling","year":"2005","unstructured":"Helling E, McKinlay AJ (2005) Considerations for the head-injured air-evacuated patient: a case report of frontal sinus fracture and review of the literature. Mil Med 170(7):577\u2013579","journal-title":"Mil Med"},{"issue":"2","key":"5297_CR12","doi-asserted-by":"publisher","first-page":"142","DOI":"10.3340\/jkns.2013.54.2.142","volume":"54","author":"J Huh","year":"2013","unstructured":"Huh J (2013) Barotrauma-induced pneumocephalus experienced by a high risk patient after commercial air travel. J Korean Neurosurg Soc 54(2):142\u2013144","journal-title":"J Korean Neurosurg Soc"},{"issue":"3 Suppl","key":"5297_CR13","doi-asserted-by":"publisher","first-page":"50","DOI":"10.7205\/MILMED-D-14-00381","volume":"180","author":"JA Johannigman","year":"2015","unstructured":"Johannigman JA, Zonies D, Dubose J, Blakeman TC, Hanseman D, Branson RD (2015) Reducing secondary insults in traumatic brain injury. Mil Med 180(3 Suppl):50\u201355","journal-title":"Mil Med"},{"issue":"1","key":"5297_CR14","doi-asserted-by":"publisher","first-page":"13626","DOI":"10.1038\/s41598-020-70614-w","volume":"10","author":"E Lim","year":"2020","unstructured":"Lim E, Lan BL, Ooi EH, Low HL (2020) Pneumocephalus and air travel: an experimental investigation on the effects of aircraft cabin pressure on intracranial pressure. Sci Rep 10(1):13626","journal-title":"Sci Rep"},{"key":"5297_CR15","doi-asserted-by":"crossref","unstructured":"Oertel MF, Korinth MC, Reinges MHT, Krings T, Terbeck S, Gilsbach JM (2006) Pathogenesis, diagnosis and management of pneumorrhachis. Eur Spine J Off Publ Eur Spine Soc Eur Spinal Deform Soc Eur Sect Cerv Spine Res Soc 15 Suppl 5(Suppl 5):636\u2013643","DOI":"10.1007\/s00586-006-0160-6"},{"key":"5297_CR16","doi-asserted-by":"publisher","first-page":"n71","DOI":"10.1136\/bmj.n71","volume":"372","author":"MJ Page","year":"2021","unstructured":"Page MJ, McKenzie JE, Bossuyt PM et al (2021) The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ 372:n71","journal-title":"BMJ"},{"issue":"1","key":"5297_CR17","doi-asserted-by":"crossref","first-page":"59","DOI":"10.3357\/AMHP.4022.2015","volume":"86","author":"B Ruddick","year":"2015","unstructured":"Ruddick B, Tomlin J (2015) Pneumocephalus and neurosurgery in rotary aircrew. Aerosp Med Hum Perform 86(1):59\u201361","journal-title":"Aerosp Med Hum Perform"},{"issue":"2","key":"5297_CR18","doi-asserted-by":"publisher","first-page":"184","DOI":"10.1080\/02688690802669351","volume":"23","author":"R Seth","year":"2009","unstructured":"Seth R, Mir S, Dhir JS, Cheeseman C, Singh J (2009) Fitness to fly post craniotomy\u2013a survey of medical advice from long-haul airline carriers. Br J Neurosurg 23(2):184\u2013187","journal-title":"Br J Neurosurg"},{"key":"5297_CR19","doi-asserted-by":"crossref","unstructured":"Sweni S, Senthilkumaran S, Balamurugan N, Thirumalaikolundusubramanian P (2013) Tension pneumocephalus: a case report with review of literature. Emerg Radiol 20(6):573\u2013578","DOI":"10.1007\/s10140-013-1135-7"},{"issue":"1","key":"5297_CR20","doi-asserted-by":"publisher","first-page":"75","DOI":"10.3357\/ASEM.3795.2014","volume":"85","author":"TJ Willson","year":"2014","unstructured":"Willson TJ, Grady C, Braxton E, Weitzel E (2014) Air travel with known pneumocephalus following outpatient sinus surgery. Aviat Space Env Med 85(1):75\u201377","journal-title":"Aviat Space Env Med"}],"container-title":["Acta Neurochirurgica"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00701-022-05297-5.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s00701-022-05297-5\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00701-022-05297-5.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,9,28]],"date-time":"2024-09-28T12:37:58Z","timestamp":1727527078000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s00701-022-05297-5"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,7,6]]},"references-count":20,"journal-issue":{"issue":"9","published-online":{"date-parts":[[2022,9]]}},"alternative-id":["5297"],"URL":"https:\/\/doi.org\/10.1007\/s00701-022-05297-5","relation":{},"ISSN":["0942-0940"],"issn-type":[{"value":"0942-0940","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,7,6]]},"assertion":[{"value":"31 January 2022","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"17 June 2022","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"6 July 2022","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"Not applicable.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval"}},{"value":"Not applicable.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent to participate"}},{"value":"Not applicable.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"The authors declare no competing interests.","order":5,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of interest"}}]}}