diving after brain surgery

[wardric]

Hello everyone,

I'm writing for my good friend and dive buddy who had some bad news recently.

The doctors annouced him that he had a brain tumor. The good news is that the surgery to remove it was successfull but the bad news is that the pathology revealed, a week later, that it was a malignous for of cancer that will come back in a max of 5 years. He will receive treatments starting next week.

He's in good shape and tries to cope with the situation but he has 2 questions related to diving:

first, he loves diving and is asking if someone can dive after a brain surgery and if so how soon after the operation.

second, he says that before knowing about the tumor, he felt a lot of pressure in his head at the surface but that the pressure was releaved when diving. He says he felt "so good" underwater. He wants to know if diving had an effet on the tumor or the pressure in his head.

Thanks to all my SB friends and docs to help my friend get some answers.

Eric

 

[DocVikingo]

Hi Eric,

The short answer is that some individuals who have undergone excision of a brain tumor do return to SCUBA. It depends upon the person's post-treatment physical and mental fitness for such a recreation.

In cases where the tumor is malignant and the individual receives post-excision chemotherapy and/or radiation treatment, return to diving cannot even be contemplated until these are complete and fitness has been assessed. Any such decision is a long way off for your friend.

As to your friend's remark that he felt a lot of pressure in his head at the surface but that this was relieved when diving, the brain contains no air-filed spaces and resides in a non-air containing compartment. It is not subject to Boyle's law and there is no apparent basis in physics for his sensation. However, it is possible that the relaxation and diversion brought on by diving, perhaps combined with some good vibes from elevated levels of ppN2, contributed to his feeling "so good" whilst diving.

Wishing your friend success in his confrontation with the tumor and its treatment.

Regards,

DocVikingo

This is educational only and does not constitute or imply a doctor-patient relationship. It is not medical advice to you or any other individual and should not be construed as such.

 

[wardric]

Thanks Doc,

About the pressure, could there be air in the tumor making it shrink with elevated pressure, therefore releaving a bit of the tension?

 

[DocVikingo]

To quote Dennis Miller, "But that's just my opinion, I could be wrong!"

Regards,

DocVikingo

 

[DocVikingo]

Thanks Doc, About the pressure, could there be air in the tumor making it shrink with elevated pressure, therefore releaving a bit of the tension?

Hey Eric,

Extremely unlikely the tumor would have contained any air spaces.

Regards,

DocVikingo

 

[TSandM]

The tumor would not contain air spaces, but it is possible that diving might affect cerebral blood flow. Hyperoxia is a vasoconstrictor, which might reduce intracranial pressure; however, many people also retain some CO2 while underwater, which is a vasodilator. What the net effect is, I don't know, but I can at least postulate a mechanism by which intracranial pressure might be somewhat relieved by being underwater.

As far as the other part of the original question, one of the biggest (and very common) complications of brain surgery and radiation is seizures. Seizures underwater are very likely to be fatal. I think your friend needs to go through all of his treatment and be out a few months, at least, from the end of it, so that he knows he's unlikely to seize, before he returns to diving. And the window of safe activity may be short, because when the tumor recurs, seizures may be the presenting symptom.

I'm very sorry to hear about this diagnosis, and I hope your friend gets a chance to enjoy the time he has as much as he possibly can. And all information we give about risks has to be evaluated in view of the bigger picture.

 

[wardric]

The tumor would not contain air spaces, but it is possible that diving might affect cerebral blood flow. Hyperoxia is a vasoconstrictor, which might reduce intracranial pressure; however, many people also retain some CO2 while underwater, which is a vasodilator. What the net effect is, I don't know, but I can at least postulate a mechanism by which intracranial pressure might be somewhat relieved by being underwater.

As far as the other part of the original question, one of the biggest (and very common) complications of brain surgery and radiation is seizures. Seizures underwater are very likely to be fatal. I think your friend needs to go through all of his treatment and be out a few months, at least, from the end of it, so that he knows he's unlikely to seize, before he returns to diving. And the window of safe activity may be short, because when the tumor recurs, seizures may be the presenting symptom.

I'm very sorry to hear about this diagnosis, and I hope your friend gets a chance to enjoy the time he has as much as he possibly can. And all information we give about risks has to be evaluated in view of the bigger picture.

Thanks Lynn,

searching for answers about the effect of pressure on his headaches is a way for him to be distracted from the situation and to cope with it.

I was diving this summer with him and at the surface, he was a bit dizzy and wanted to go underwater asap since he knew the pressure would be relieved. He was then associating it with everyday stress. He normally is the one offering to carry the flag but I had strangely noticed that he didn't that day. I carried the flag and found him to be nervous and disoriented during that dive. He just told me that at the time, he was feeling a loss of dexterity in his left hand (he's a lefty) and knew he couldn't carry the flag for the whole dive. We dived only once together after that and it went a bit better.

He might come to check on answers since he has an SB account (never really used it or posted though) so If we can focus on his case, or similar cases, it would be appreciated.

Thanks Doc and Lynn

 

[cutlass]

Basically, tumors cause pain by infiltrating and displacing normal structures. Scuba diving may help shrink tissue enough to provide some relief. One is dehydration from urination due to submersion and moisture loss from breathing super-dry gas. Two is that the increased partial pressure of oxygen at depth may cause a reflex shrinking of blood vessels.

Obviously, whether he's cleared to dive depends on consultation with his doctor(s). But if he's healed well and cleared for strenuous activity and any medication or treatment side-effects are manageable, I would like to think that he could dive. As long as their condition is well managed or stable, people with all sorts of special needs do dive. Of course, they may require different levels of restrictions, assistance, or supervision.

Although he's been MIA from this board for awhile, you might try shooting a wake-up PM to shakeybrainsurgeon. He's maintained a neurosurgical consulting practice and took up scuba diving despite having his own challenges which effectively ended his OR time.

 

[DocVikingo]

Scuba diving may help shrink tissue enough to provide some relief. One is dehydration from urination due to submersion and moisture loss from breathing super-dry gas. Two is that the increased partial pressure of oxygen at depth may cause a reflex shrinking of blood vessels.

Hi cutlass,

How much shrinkage, percentage-wise, do think these mechanisms might afford?

How about v mannitol?

Thanks,

DocV

 

[Duke Dive Medicine]

Eric,
Some people have a bony dehiscence in one or more sinuses that essentially puts the dura in direct contact with the outside of the sinus membrane. It's possible that your friend could have experienced some relief of pressure if he has this anatomic variance and the affected sinus was compressed on descent. Like DocV and Lynne said, tumors generally don't contain free gas unless they're necrotic, and brain CA is pretty unlikely to get to that stage.

I think you'd be hard pressed to get enough tissue shrinkage to cause relief just from the increased pO2 of SCUBA diving. On top of the possibility of CO2 retention and vasodilation like Lynne mentioned, at a minimum, it takes a pO2 of about 0.6 ATA to get any anti-inflammatory effect from oxygen. If we're shooting for that in a treatment we'll use at least 2 ATA and sometimes up to 3.

Sorry to hear about your friend's diagnosis. Good luck to him.

Best regards,
DDM