Enlarged Foramen Ovale-Caused Meningeal Bulge in a Pilot

BACKGROUND: Meningocele results from a defect in the skull base bone, causing meningeal prolapse. Clinical manifestations of meningocele are often nonspecific and prone to misdiagnosis. Inadequate treatment may lead to severe complications, including cerebrospinal fluid leakage, meningitis, or, in rare cases, epilepsy, thereby posing significant risks to patients involved in aerospace operations. Historically, meningocele cases have predominantly been reported in fetuses and infants, with limited analysis and documentation focused on adults, particularly aviation pilots.

CASE REPORT: During a routine annual physical examination, a male student pilot was found to have an enlarged right foramen ovale accompanied by meningocele. Imaging via 3T magnetic resonance imaging and computed tomography scans revealed a tubular, beaded cystic formation in the right parapharyngeal space, indicating meningocele with an enlarged right foramen ovale and confirming its location at the right middle cranial base. Given the structural abnormality, it was assessed that the pilot is unsuitable for exposure to high acceleration forces. Consequently, he was restricted to operating non-high-performance aircraft, such as bombers, helicopters, and carrier-based aircraft.

DISCUSSION: Treatment and flight duty determinations for affected pilots must consider individual case specifics. In this instance, the absence of pre-examination symptoms suggested minimal clinical severity, negating the need for surgical intervention. To ensure both flight safety and pilot health, thorough pre-enlistment physical screenings and ongoing assessments throughout a pilot’s career are crucial for accurately evaluating physical readiness.

Zhai J, Liu S, Gao D, Yao Y. Enlarged foramen ovale-caused meningeal bulge in a pilot. Aerosp Med Hum Perform. 2025; 96(3):251–254.