Abstract
Introduction
Patients with intracranial masses are often advised to avoid airflight due to concerns of worsening neurological symptoms or deterioration. However, many patients often travel cross-country or internationally to tertiary care centers for definitive care. This study assesses the safety of commercial airflight for brain and skull base tumor patients without severe or progressive neurological deficits.
Methods
Patients that had traveled to our institution for surgery via commercial airflight from 2014 to 2017 were identified. An electronic survey was administered (RedCap) and flight duration, aircraft type, presenting symptoms and new or worsened peri-flight symptoms were queried. Severity was assessed using visual analogue scale (VAS). Significant change of symptoms was determined to be greater than 25%. Demographics and clinical history were obtained from electronic medical records. Providence Health System IRB: 16–168.
Results
Of 665 patients operated on for brain tumor, 63 (9.5%) traveled by airflight to our center for surgery and of these, 41 (65%) completed the study (mean age 48.5 ± 16.8 years, 63% female). Pathology included pituitary and other parasellar tumors (58%), meningiomas (22%), metastatic tumors (5%), gliomas (5%), pineal tumor (5%), cerebello-pontine tumor (5%). Average tumor volume was 11.4 cc and average maximal dimension was 2.7 cm. Ten (24.4%) patients developed worsened symptoms during airflight including: headaches 3/19 (15.8%), fatigue 3/14 (21.4%), dizziness 3/5 (60%) and ear pain 3/3 (100%), as well as one patient who had new onset seizures inflight. Seven patients (70%) sustained worsened symptoms after airflight. There were no permanent neurological deficits related to airflight. There was no correlation with tumor size, volume, location or flight duration with development of neurological symptoms. There was an inverse correlation between peri-flight corticosteroid usage and symptom exacerbation (p = 0.048). No patient with completely asymptomatic tumors developed new symptoms during flight.
Conclusions
Most patients with brain and skull base tumors can travel safely via commercial airflight with acceptable symptom exacerbation. However, consideration should be given to administering corticosteroids and possibly anticonvulsants to patients who are symptomatic and/or have relatively large tumors with mass effect and peritumoral edema.
Similar content being viewed by others
References
Cummins RO, Chapman PJ, Chamberlain DA, Schubach JA, Litwin PE (1988) In-flight deaths during commercial air travel. How big is the problem? JAMA 259:1983–1988
Gendreau M, DeJohn C (2002) Responding to medical events during commercial airline flights. N Engl J Med 346:1067
Bailey DM, Bärtsch P, Knauth M, Baumgartner RW (2009) Emerging concepts in acute mountain sickness and high-altitude cerebral edema: from the molecular to the morphological. Cell Mol Life Sci 66:3583–3594
Zrinzo LU, Crocker M, Zrinzo LV, Thomas DG, Watkins L (2006) Commercial flight and patients with intracranial mass lesions: a caveat. Report of two cases. J Neurosurg 105:627–630. https://doi.org/10.3171/jns.2006.105.4.627
Litch JA, Basnyat B, Zimmerman M (1997) Subarachnoid hemorrhage at high altitude. West J Med 167:180–181
Wilson MH, Newman S, Imray CH (2009) The cerebral effects of ascent to high altitudes. Lancet Neurol 8:175–191. https://doi.org/10.1016/S1474-4422(09)70014-6
Shlim DR, Nepal K, Meijer HJ (1991) Suddenly symptomatic brain tumors at altitude. Ann Emerg Med 20:315–316
Hampson NB, Kregenow DA, Mahoney AM, Kirtland SH, Horan KL, Holm JR, Gerbino AJ (2013) Altitude exposures during commercial flight: a reappraisal. Aviat Space Environ Med 84:27–31
Hackett P, Roach R, Wood R, Foutch R, Meehan R, Rennie D, Mills W Jr (1988) Dexamethasone for prevention and treatment of acute mountain sickness. Aviat Space Environ Med 59:950
Johnson T, Rock P, Fulco C, Trad L, Spark R, Maher J (1984) Prevention of acute mountain sickness by dexamethasone. N Engl J Med 310:683
Rock P, Johnson T, Larsen R, Fulco C, Trad L, Cymerman A (1989) Dexamethasone as prophylaxis for acute mountain sickness. Effect of dose level. Chest 95:568
Bodack MI (2003) Blurred vision during airline flight reveals prolactinoma. Optometry 74:159–172
Funding
Funding was provided by Pacific Neuroscience Institute.
Author information
Authors and Affiliations
Corresponding author
Electronic supplementary material
Below is the link to the electronic supplementary material.
Rights and permissions
About this article
Cite this article
Phillips, M., Saria, M., Eisenberg, A. et al. Safety of commercial airflight in patients with brain tumors: a case series. J Neurooncol 139, 617–623 (2018). https://doi.org/10.1007/s11060-018-2905-6
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s11060-018-2905-6