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 <10 mL (50% of surgeons cleared immediately; otherwise, 1.7 (2.1) wk). Pneumocephalus severity influenced clearance time and preflight imaging recommendations. DISCUSSION: Compared to existing guidelines, we found distinct flight clearance timelines and varying preflight imaging recommendations for different operation types. Variability of responses highlights the need for further research as well as surgeon education on altitude physiology and aeromedical risk factors. Mampre D, Rupp C, Wilson J, Kelbert J, Riha G, Richardson M, Hooten K, Lindgren J, Alves P, Petersen E, Hilliard JD. Postoperative recommendations for commercial air travel after neurosurgical intervention. Aerosp Med Hum Perform. 2026; 97(6):411-418.