Safety of commercial airflight in patients with brain tumors: a case series

Michelle Phillips, Marlon Saria, Amy Eisenberg, Daniel F. Kelly, Garni Barkhoudarian

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. 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. 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. 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.