What is the importance of the clivus?
The clivus is the most profound bone of the skull base; it protects the brainstem and adjacent major vascular structures and provides mechanical support for the cranial vault.
What is the risk for patients with a clival fracture?
The main risk for patients with a clival fracture is neurovascular deficiencies due to the anatomic proximity to cranial nerves, the brainstem, and the vertebrobasilar artery. Fractures of the clivus have a high rate of complications.
Which cranial nerves are at risk of injuries in clival fractures?
Patients with clival fractures may present cranial nerve deficits, including II, III, IV, V, VI, VII, VIII, IX, and XI.
Why do many patients with fractures of the clivus have bilateral VI nerve palsies?
Many patients with a head injury presenting fractures of the clivus have bilateral VI nerve palsies due to the proximity of Durello’s canal to the lateral aspect of the clivus.
Which is the modality of choice to identify CT clival fracture?
CT is the modality of choice to identify clival fractures.
What is the Corradino CT-based classification for clival fractures?
The Corradino CT-based classification for fracture of the clivus is longitudinal, transverse, and oblique types, depending on the CT orientation.
Which CT type of fracture of the clivus has the worst prognosis?
Patients with longitudinal fractures of the clivus have the worst prognosis and higher mortality rate due to the associated injury to the brainstem and vascular brainstem injuries. Transverse and oblique fractures of the clivus have a better prognosis and are most frequently associated with vascular injury of anterior circulation.
What condition is associated with poor prognosis in clival fractures?
Many clival fractures have a poor prognosis due to proximity to the brainstem and the high incidence of vascular injury. A vertebrobasilar artery occlusion trapping has a poor prognosis.
CT scans demonstrate a centrally transverse fracture line extending through the basiocciput (clivus) associated with occipital skull vault fractures. CT also reveals right frontal subdural hematoma, left parietal subarachnoid hemorrhage, hemorrhagic contusions in frontal lobe bilaterally, brain edema, and sphenoid hemosinus.
Impression: Traumatic brain injury with skull vault fractures and a transverse clival fracture, associated with intracranial hemorrhage.