Clivus fractures: clinical presentations and courses

Abstract

Fractures in the clivus region are usually associated with blunt head trauma. They may cause many cranial nerve deficits and vascular complications. The mortality rate is high because of brainstem trauma or vertebrobasilar occlusion. The diagnosis of clivus fracture (CF) is difficult with routine cranial radiography due to the presence of dense petrous temporal bones. Because of this, few cases have been described in the past. In this study, we report nine cases of CF observed and treated in our department during the last 5 years. Computed tomographic (CT) scanning revealed CF in nine of 2500 patients with head trauma (0.36%). The patients ranged in age from 17 to 68 years (mean 38.3). Five patients had had motor vehicle accidents, three were injured in falls, and one was a pedestrian injured by a motor vehicle. Five patients had longitudinal fractures and four had transverse fractures. Cranial nerve deficits were recorded in all patients. Deficits of cranial nerves VI and VII were the most frequently observed (six patients, 66.6%). We review the literature to highlight the differences in clinical presentation and the course in cranial nerve deficits. The diagnosis of CF is made by high-resolution, fine-cut CT using standard and bone window settings. Its presence should alert clinicians to the potential complications.

Clival fractures in a Level I trauma center

“…Indeed, previous estimates of CF have shown an incidence among head trauma patients of 0.21% 33 and 0.56% 7 in an adult population admitted to hospital. Another study showed an incidence of 0.36%, 29 but the base population was not defined. The reported incidence in a pediatric population is 0.4%.…”

“…tures 3,7,12,33,41,44 and damage to the anterior circulation and surrounding cranial nerves in oblique or transverse fractures; 7,24,29,33 however, defining clinical presentations according to CF orientation remains inconsistent in the literature. The objective of this study was therefore to introduce a system of CF classification according to degree of displacement as well as orientation, and to determine if clinical presentation, course, and outcome differ among these unique fracture subtypes.…”

Traumatic Longitudinal Clival Fracture in a Child -Case Report-

“…4) Longitudinal clival 4,7,8,11,14) Most cases of longitudinal clival fracture resulted in death (mortality rate 67-80%) or residual disability of the patient (mean age 40 years). Only four adult patients 2,7,11) (18,20,32, and 42 years old) suffered minimal neurological damage. Traumatic severe brain damage is often discovered in addition to brain stem damage or vascular accident in patients with clivus fracture.…”

“…3) A total of 51 cases of fractures of the clivus due to head injury have been reported, mostly in adults who suffered serious vascular and cranial nerve damage. [1][2][3][4][5][7][8][9][10][11][12][13][14][15][16][17][18] Longitudinal clival fractures were identified in 29 cases, including four in children.…”

Occipital Condyle Fracture Extending to the Inferior Part of the Clivus

“…In their retrospective studies on clivus fractures, Corradino et al [6] found a clivus fracture in 17 (0.56%) out of 3,000 patients and Menku et al [7] in 9 out of 2,500 patients. In the literature, there is no report on the incidence of the copresence of occipital condyle fracture and clivus fracture, but only a few case reports.…”