Clival fractures in a Level I trauma center

Winkler-Schwartz, Alexander; Correa, José A.; Marcoux, Judith

doi:10.3171/2014.9.jns14245

Cited by 25 publications

(23 citation statements)

References 41 publications

(32 reference statements)

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“…Cranial neuropathy is an expected consequence of these fractures, as these have an incidence of cranial neuropathy of approximately 100%. 9,10 High mortality and morbidity of clival fractures can be attributed to higher incidence of brainstem insults associated with these types of fractures, and this is not unexpected given that the clivus rests immediately anterior to the pons.…”

Section: Anatomymentioning

confidence: 99%

Skull Base Trauma: Clinical Considerations in Evaluation and Diagnosis and Review of Management Techniques and Surgical Approaches

Feldman¹,

Farnoosh²,

Kellman³

et al. 2017

Seminars in Plastic Surgery

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).The head, deservedly, has been coined the central hub of individuality and communication with the outside world. By virtue of the critical structures encompassed by the craniofacial skeleton, head trauma can have devastating and debilitating consequences. With advancement of our understanding of brain trauma, technology, and medicine, more victims survive to face the sequelae of what were once terminal injuries. There are 30 million trauma-related hospital visits annually, and approximately 16% are associated with traumatic brain injuries (TBIs). Children, older adolescents, and adults aged 65 years or older are among those most likely to sustain TBIs. The incidence of TBIs is also higher in males. As per the Centers for Disease Control and Prevention (CDC) report, males aged 0 to 4 years have the highest rates of TBI-related emergency department visits. However, the rate of hospitalization and death is higher amongst patients 65 years of age and older. Mechanism of injury leading to TBI varies among the demographic parameters. For example, assault and motorized vehicle crashes are major causes of TBI-related deaths up to the third decade of life, whereas falls are implicated in most of the TBI-related deaths in individuals 65 years of age and older population. In 2010, $76.5 billion was the estimated economic burden of TBI. 1 In light of the societal and financial burdens involved in cranial trauma and as a result of critical anatomic relationships between important neurologic structures, such as the brain and skull, skull base injuries are an important part of the head trauma mélange. Skull base fractures have been reported in 12% of all head injuries and 20% of all skull fractures. 2 With the skull base being located at the anatomic gateway of neurovascular connections of the brain with the periphery, timely diagnosis and management of skull base fractures and their complications are of paramount importance. This work aims to briefly review demographics, diagnosis, complications, and surgical management of skull base injuries. Mechanism of Injury AbstractTraumatic injuries to the skull base can involve critical neurovascular structures and present with symptoms and signs that must be recognized by physicians tasked with management of trauma patients. This article provides a review of skull base anatomy and outlines demographic features in skull base trauma. The manifestations of various skull base injuries, including CSF leaks, facial paralysis, anosmia, and cranial nerve injury, are discussed, as are appropriate diagnostic and radiographic testing in patients with such injuries. While conservative management is sometimes appropriate in skull base trauma, surgical access to the skull base for reconstruction of traumatic injuries may be required. A variety of specific surgical approaches to the anterior cranial fossa are discussed, including the classic anterior craniofacial approach as well as less invasive and newer endoscope-assisted approaches to the traumatized skull base.

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Section: Anatomymentioning

confidence: 99%

Skull Base Trauma: Clinical Considerations in Evaluation and Diagnosis and Review of Management Techniques and Surgical Approaches

Feldman¹,

Farnoosh²,

Kellman³

et al. 2017

Seminars in Plastic Surgery

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“…The clivus is the strongest bone of the skull base, provides mechanical support for the cranial vault and protection for the brainstem and adjacent major vascular structures. Despite its deep location is very susceptible to related fractures with consequent high mortality rate or poor outcome for survivors [1,2].…”

Section: Introductionmentioning

confidence: 99%

Utility of post mortem computed tomography in clivus fracture diagnosis. Case illustration and literature review

Zerbo

Piazza

et al. 2018

Legal Medicine

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“…The clivus is the deepest bone of the skull base and is rarely injured. The incidence of clival fracture among all patients admitted with traumatic brain injury is 1.2% ( 6 ). Clival fracture is classified based on its direction into the longitudinal, oblique, and transverse subtypes ( 6 , 7 ).…”

Section: Introductionmentioning

confidence: 99%

“…The incidence of clival fracture among all patients admitted with traumatic brain injury is 1.2% ( 6 ). Clival fracture is classified based on its direction into the longitudinal, oblique, and transverse subtypes ( 6 , 7 ). It is further classified based on the quality of the fracture into the hairline, linear, diastatic, and displaced subtypes ( 6 ).…”

Section: Introductionmentioning

confidence: 99%

“…Clival fracture is classified based on its direction into the longitudinal, oblique, and transverse subtypes ( 6 , 7 ). It is further classified based on the quality of the fracture into the hairline, linear, diastatic, and displaced subtypes ( 6 ). We herein report the unusual case of a patient who developed bacterial meningitis caused by the leakage of CSF into the sphenoid sinus due to a clival fracture.…”

Section: Introductionmentioning

confidence: 99%

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Cerebrospinal Fluid Rhinorrhea and Subsequent Bacterial Meningitis due to an Atypical Clival Fracture

Tohge

Takahashi

2017

Intern. Med.

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Cases of cerebrospinal fluid (CSF) rhinorrhea due to clival fracture are rare. We present a case of bacterial meningitis with CSF rhinorrhea after a clival fracture. Heavily T2-weighted images showed a bone flap in the thinned clivus and fluid collection in the sphenoid sinus. CSF rhinorrhea developed at 1 month after mild trauma. The fracture may have been caused by the trauma and/or by the pressure gradient between the intracranial CSF space and the sphenoid sinus. A detailed history to identify trauma and an examination to detect bone defects in the skull base are necessary when patients present with bacterial meningitis and persistent rhinorrhea.

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Clival fractures in a Level I trauma center

Abstract: This study provides information on the largest CF population studied to date, expands the current CF classification to include fracture quality as well as orientation, and underscores the existence of significant differences in pathogenesis and clinical presentation of CF subtypes.

Cited by 25 publications

References 41 publications

Skull Base Trauma: Clinical Considerations in Evaluation and Diagnosis and Review of Management Techniques and Surgical Approaches

Skull Base Trauma: Clinical Considerations in Evaluation and Diagnosis and Review of Management Techniques and Surgical Approaches

Utility of post mortem computed tomography in clivus fracture diagnosis. Case illustration and literature review

Cerebrospinal Fluid Rhinorrhea and Subsequent Bacterial Meningitis due to an Atypical Clival Fracture

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