• Anastasia Tasiou, Christos Tzerefos, Maria Karagianni, Eleni Tsianaka, Mark Jarratt, Nurperi Gazioğlu, Konstantinos Peramatzis, Marike Ld Broekman, Ana Rodríguez-Hernández, Daniela L Ivan, Insa K Janssen, Maria Karampouga, Xanthoula Lambrianou, Stiliana Mihaylova, Ayşegül Esen Aydin, Silvia Hernandez-Duran, Niina Salokorpi, Gail Rosseau, and Mary Murphy.
• Department of Neurosurgery, University Hospital of Larissa, Larissa, Greece. Electronic address: ttasiou@yahoo.com.
• World Neurosurg. 2025 Feb 8; 195: 123692123692.

ObjectiveNeurosurgical care is difficult to access in many scenarios. Aeromedical evacuation of acutely unwell neurosurgical patients from remote, isolated, or poorly equipped locations can be considered. This article aims to provide a framework of logistical factors that deserve special consideration in the preparation of these patients for transfer.MethodsWe searched all relevant medical literature, military reports, and travel industry documents on transfer of neurosurgical patients. This review was combined with a senior author's (M.J.) extensive relevant experience, to present important factors for neurosurgeons to consider during planning of aeromedical evacuation, highlighting potential preventable causes of deterioration en route.ResultsSeveral criteria must be met for a transfer to be considered. The safe transfer of patients with craniospinal pathology requires efficient collaboration between the referring teams, the receiving units/departments, and the medical transfer service. Clear communication, qualified personnel, and appropriate transportation equipment must be available for the transfer. One must consider unique stressors during the air transfer, including the risk of hypoxia on certain types of flights. Vibration, loud noise, acceleration, and changes in barometric pressure en route may negatively affect the patient during transfer. Patient stabilization before transfer is a priority. Medical conditions that can potentially worsen in-flight should be corrected before transfer. The use of a checklist before departure is highly recommended and is included herein. The timing of transfer concerning the postoperative patient deserves special consideration.ConclusionsAlthough there is little published information, this review provides useful criteria and parameters needed for safe aeromedical evacuation of neurosurgical patients.Copyright © 2025 The Authors. Published by Elsevier Inc. All rights reserved.

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