Fitness to dive after craniotomy / brain surgery

An individual who wishes to return to diving will require an assessment by a medical referee after:

• a craniotomy
• surgery to other parts of the skull that penetrates the intracranial space or other gas filled space in the skull, or
• any other intracranial procedure including treatments such as radiotherapy, gamma knife surgery, proton beam therapy and interventional radiology including percutaneous thrombectomy following a stroke

The Medical Referee must confirm (with the assistance of any communications that the diver has had with the neurosurgical team) that:

• the underlying disorder being treated and treatment received are compatible with diving
• there has been an adequate neurological recovery of co-ordination, motor, sensory and higher mental function
• in the case of pituitary surgery, the endocrinological profile must have returned to within normal limits
• the risk of seizure has reduced to a tolerable level
  • a reasonable threshold for this is fulfilling the requirements of the UK Driver and Vehicle Licensing Agency for Group 1 drivers (personal cars and motorcycles) without requiring the use of anti-epileptic medications
• it is unlikely that hydrocephalus will develop; the prospective diver must be given some indication of the likelihood of such an event by the treating neurosurgeon. If it does develop, it must be adequately treated
• it is unlikely that there will be an unpredictable and rapid decline in health which could incapacitate the diver or mimic a serious diving disorder
• there are no sequelae that make the diver vulnerable to other hazards in the diving environment such as infection or barotrauma
  • all wounds (including any breaches of sinus walls and other gas filled spaces) have healed adequately – if part of the skull has been replaced by mesh or other implant, the implant and its safe location in the skull must not be affected by pressure-related changes in gas volume
  • sinuses and any other gas-filled spaces must ventilate freely to allow gas to expand and compress without the risk of ingress of
    • gas into soft tissue spaces such as the orbit and nerve canals, the intracranial space or other fluid filled spaces such as inner ear or venous sinuses
    • water or contamination into the intracranial space or any other spaces susceptible to infection eg the mastoid space

[Published 12 February 2026]