Air Transport of a Patient With Impending Cerebral Herniation From Tension Pneumocephalus.

Tension pneumocephalus is a rare but dangerous complication of craniotomy, sinus surgery, and traumatic cranial injury. Compared with simple pneumocephalus, which often resolves spontaneously over the course of a few days, tension pneumocephalus tends to increase with ongoing cerebrospinal fluid leak and requires immediate neurosurgical treatment to prevent cerebral herniation. Air transport of patients with tension pneumocephalus for neurosurgical care entails a risk of neurologic worsening because of changes in ambient air pressure with altitude and cabin pressurization. We describe a case in which severe symptomatic tension pneumocephalus developed after endoscopic endonasal sinus surgery in an 81-year-old man. The patient lived in a remote area and required air transport for medical care. Pretreatment with oxygen therapy and maintaining the patient in a flat supine position rapidly improved his neurologic status, allowing transportation without incidence. A recommendation was also made to the medical transport team to fly at the lowest possible altitude. Specific precautions may enable safe transport of these critically ill patients for treatment, although further data must be obtained before these can be definitively recommended.