ReviewBrain & spine2026
Intercontinental aeromedical transfers after decompressive craniectomy for severe traumatic brain injury: Systematic review and evidence-informed fitness-to-fly pathway.
Review in Brain & spine, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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Authors and funding
9 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
Background: Traumatic brain injury (TBI) sustained abroad creates major clinical, logistical, and psychosocial challenges. Guidance on the timing and safety of aeromedical repatriation after cranial surgery remains inconsistent and largely unvalidated. Case description: A 26-year-old foreign national presented unconscious after a hotel-balcony fall. Computed tomography showed a right frontotemporoparietal acute subdural haematoma with bilateral basifrontal contusions. Intervention and outcome: Following resuscitation, he underwent decompressive craniectomy and haematoma evacuation. After tracheostomy and neurocritical-care stabilization, multidisciplinary coordination was undertaken with his family, insurer, authorities, and receiving centre. Pre-flight assessment confirmed neurological and cardiopulmonary stability, secure airway and ventilation, and absence of pneumocephalus and pneumothorax. Three weeks after surgery, transfer by ventilator-equipped fixed-wing air ambulance was completed without reported complications. Systematic review: A PRISMA 2020-aligned focused review was conducted on aeromedical transfers for patients after decompressive craniectomy for severe TBI. Of 737 records identified, 58 full-text reports were assessed, and twenty-six primary studies were included in the narrative synthesis; eight professional guidance, consensus, and regulatory documents were synthesized separately. Evidence was heterogeneous, comprising mainly retrospective military cohorts, surveys, mechanistic models, and case reports. Secondary physiological insults during transport-not elapsed postoperative time alone-were the recurring risk. Evidence relating intracranial-air volume to deterioration was inconsistent, and no universally safe volume or validated post-craniectomy interval was identified. Conclusion: Long-distance repatriation after decompressive craniectomy may be feasible following structured multidisciplinary assessment, physiological optimisation, exclusion of trapped intracranial or thoracic air, and appropriate cabin-pressure and monitoring strategies. The proposed defer/conditional/ready pathway requires prospective validation.
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