Fractures of the Clivus: Classification and Clinical Features

Abstract

Fractures of the clival complex were diagnosed in a series of 17 patients admitted to the Maryland Institute for Emergency Medical Services System and the University of Maryland Medical System over a 30-month period. These fractures were divided pathologically into three types based upon their appearance on computed tomography: longitudinal, transverse, and oblique. The mechanisms of injury were similar in all groups, and the Glasgow Coma Scale scores at admission were comparable, regardless of fracture type, in survivors and nonsurvivors. Longitudinal fractures were associated with servere injury to the central nervous system and with brain stem infarction, and 4 of 6 (67%) of these patients died. Transverse fractures of the clival complex were found in 6 patients, 3 of whom (50%) died. All of these patients had fractures of the petrous ridge; 2 of the 3 survivors had multiple cranial nerve deficits, and one patient developed a carotid-cavernous fistula. Of the 5 patients with oblique clival fractures. 2 survived (40%), both of whom had multiple cranial nerve palsies; in addition, one of these patients developed a carotid-cavernous fistula. Using the present generation of computed tomographic scanners, fractures of the clival complex can be reliably diagnosed; they are probably more common than previously believed and can be separated into three groups based on the characteristics on computed tomographic scans and clinical findings.

Cervical epidural haematoma with clivus fracture: case report

“…Its deep localization, together with the anatomical center of the skull base protected by the facial structures, bone of the medial fosse and occipitium, makes the site infrequent to fractures 2,3 . The diagnosis is difficult by the imaging superposition in the x-ray and is usually described post-mortem 2,4 .…”

“…The mechanical forces responsible for the fracure are still under continuous controversy, but there had been described vertical 2 , lateral 2 and anterior-posterior forces 2,5,18 involved in these fractures. Radiologically, the clivus fractures can be classified as longitudinal, transverse and oblique 2,18 .…”

“…Radiologically, the clivus fractures can be classified as longitudinal, transverse and oblique 2,18 .…”

“…The oblique fractures (29,4%) initiate at the lateral region of the dorsum sellae, ending at the contralateral petroclival fissure, and manifests by vascular lesions of the internal carotid artery, cranial nerve lesions (like Collet-Sicard syndrome) and by CSF fistulas 2,19 .…”

“…Os autores apresentam também uma revisão da literatura pertinente. Clivus fractures are rare entities and are usually associated with vascular or cranial nerve lesions [1][2][3][4][5] . They are frequently diagnosed postmortem 4 and can be classified radiologically on: longitudinal, transverse or oblique fractures.…”