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Clivus fracture

Necati Ucler, Seyho Cem Yucetas
Although rarely reported in the literature, serious occipital and condylar fractures have been diagnosed more often with the widespread use of computed cranial tomography in traumas. In this paper, a 16-year-old female with a left occipital fracture extending from the left occipital condyle anterior of the hypoglossal canal to the inferior part of the clivus is presented. The fracture which had caused a neurological deficit was cured with conservative treatment. For delayed hypoglossal nerve paralysis due to swelling within the canal, methylprednisolone was started, and a complete cure was attained in about 10 days...
March 22, 2018: Pediatric Neurosurgery
S Zerbo, A Di Piazza, G Lo Re, G L Aronica, S Salerno, R Lagalla
Clivus fractures are usually associated with head blunt trauma due to traffic accident and falls. A 23 - year-old man died immediately after a smash-up while he was stopping on his motorcycle. Post-mortem Computed tomography (PMCT), performed before autopsy, revealed a complex basilar skull base fractures associated with brainstem and cranio-vertebral junction injuries, improving the diagnostic performance of conventional autopsy. Imaging data were re-assessable and PMCT offers the possibility to perform multiplanar and volume rendered reconstructions, increasing forensic medicine knowledge related to traumatic injuries...
January 2018: Legal Medicine
Rie Tohge, Makio Takahashi
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...
2017: Internal Medicine
Barbara Lerhe, Sarah Alshehri, Denis Ferachon, Sébastien Dejean, Anne Sophie Salabert, Raphael Lopez
BACKGROUND: The available referential measures defining the zygomatic bone morphology are adequate enough for full determination of the zygoma positioning, especially for trauma surgery, but osteometric analysis of the zygoma positioning based on tomographic examinations could be useful in peroperative and postoperative imaging. In this study, we propose referential measures, taking into account the morphology and the symmetry of the zygoma. In addition, the reliability and reproducibility are considered...
January 2017: Journal of Cranio-maxillo-facial Surgery
Stefan Kliesch, Christian Bauknecht, Georg Bohner, Thomas Liebig, Eberhard Siebert
We report a rare case of entrapment of the basilar artery into the sphenoid bone caused by a longitudinal fracture of the clivus. Using high resolution three-dimensional flat panel angiography, we show preservation of the basilar artery perforators in spite of severe stenosis of the entrapped segment of the basilar artery. There were no obvious signs and symptoms of posterior fossa stroke clinically or radiographically as far as could be assessed under given clinical circumstances.
May 2017: Journal of Neurointerventional Surgery
Stefan Kliesch, Christian Bauknecht, Georg Bohner, Thomas Liebig, Eberhard Siebert
We report a rare case of entrapment of the basilar artery into the sphenoid bone caused by a longitudinal fracture of the clivus. Using high resolution three-dimensional flat panel angiography, we show preservation of the basilar artery perforators in spite of severe stenosis of the entrapped segment of the basilar artery. There were no obvious signs and symptoms of posterior fossa stroke clinically or radiographically as far as could be assessed under given clinical circumstances.
September 19, 2016: BMJ Case Reports
P Wu, Z Y Yang, Y Liu, Y Li, Y H Tan
OBJECTIVE: To analyze the impact of maxillofacial injury on skull base. METHODS: A three-dimensional(3D)finite-element model of cranio-maxillofacial bone was established by CT scan data. A lead cylinder in base diameter of 3 cm was designed as an impactor. There regions(upper right maxilla, left infraorbital margin and left zygomatic body)subjected to an impact at the speed of 8.6 m/s(about 30 km/h)was simulated. Thirteen landmarks at the skull base were selected...
August 2016: Zhonghua Kou Qiang Yi Xue za Zhi, Zhonghua Kouqiang Yixue Zazhi, Chinese Journal of Stomatology
Ali Z Syed, Samir Zahedpasha, Sonali A Rathore, Mel Mupparapu
The aim of this report is to present two cases of canalis basilaris medianus as identified on cone-beam computed tomography (CBCT) in the base of the skull. The CBCT data sets were sent for radiographic consultation. In both cases, multi-planar views revealed an osseous defect in the base of the skull in the clivus region, the sagittal view showed a unilateral, well-defined, non-corticated, track-like low-attenuation osseous defect in the clivus. The appearance of the defect was highly reminiscent of a fracture of the clivus...
June 2016: Imaging Science in Dentistry
Shota Yamamoto, Shingo Toyota, Hajime Nakamura, Kanji Mori, Takuyu Taki, Toshiki Yoshimine
BACKGROUND: Vertebrobasilar artery entrapment resulting from a clivus fracture is rare. The entrapped lesions are not radiographically depicted precisely because they are only identified by autopsy or completely occluded. In addition, no changes in the features have been revealed clearly because radiologic examinations were performed only in the acute stage. CASE DESCRIPTION: We report a case of traumatic entrapment of the vertebral artery depicted precisely by a three-dimensional angiographic study in the subacute stage, presenting the serial changes in the morphologic features and a review of the published cases...
November 2016: World Neurosurgery
Shadi Al-Afif, Makoto Nakamura, Thomas Lenarz, Joachim K Krauss
OBJECTIVES: Routine transnasal rhinological procedures are widely practiced and are considered as safe, in general. Skull base lesions occur in less than 1% of procedures and typically involve the anterior or middle cranial fossa, while clivus lesions have not been well documented. Here we present a series of three patients with iatrogenic transclival lesions after routine transnasal rhinological procedures. PATIENTS AND METHODS: Three patients with penetrating clivus injuries after routine transnasal rhinological procedures were identified...
June 2016: Clinical Neurology and Neurosurgery
Brandon D Liebelt, Zain Boghani, Ali S Haider, Masayoshi Takashima
Unlike basilar skull fractures, penetrating traumatic injuries to the clivus are uncommon. We present two novel and interesting cases of traumatic crossbow arrow injury and penetrating screwdriver injury to the clivus. A review of the literature describing methods to repair these injuries was performed. A careful, systematic approach is required when working up and treating these injuries, as airway preservation is critical. An adaptation to the previously described "gasket-seal" method for skull base repair was utilized to repair the traumatic cerebrospinal fluid (CSF) fistulas...
June 2016: Journal of Clinical Neuroscience: Official Journal of the Neurosurgical Society of Australasia
Akihiro Hirayama, Fuminari Komatsu, Kazuko Hotta, Masaaki Imai, Shinri Oda, Masami Shimoda, Mitsunori Matsumae
An 89-year-old male presented with cerebrospinal fluid (CSF) rhinorrhea associated with head trauma sustained as a pedestrian in a traffic accident. Computed tomography (CT) showed pneumocephalus and multiple cranial bone fractures, including the clivus. Although the CSF rhinorrhea was treated conservatively for a week, clinical symptoms did not improve and surgical repair was performed. Preoperative thin-sliced bone CT and steady-state magnetic resonance images revealed a bone defect at the middle clivus and a collection of CSF fluid from the clival fistula in the sphenoid sinus...
2016: Neurologia Medico-chirurgica
M Májovský, D Netuka, V Masopust, V Beneš
INTRODUCTION: Clivus is a central structure of the skull base located in the vicinity of the brainstem and vital brain vessels. Clival fractures are usually caused by a high-energy trauma. Cerebrospinal fluid leak is one of the most common complications. CASE REPORT: A middle-aged male sustained a mild head trauma, followed by a nasal cerebrospinal fluid leak. CT scan revealed the massive pneumocephalus and the fracture of the clivus in the posterior wall of the sphenoidal sinus...
July 2015: Rozhledy V Chirurgii: Měsíčník Československé Chirurgické Společnosti
Tenoch Herrada-Pineda, Mauro Loyo-Varela, Francisco Revilla-Pacheco, Monika Uribe-Leitz, Salvador Manrique-Guzmán
BACKGROUND: Cranieovertebral junction lesions in the paediatric population are associated with a low survival rate, which has declined in recent years. Neurological disability is a major concern due to the high economical cost it represents. Paediatric patients are more susceptible to this lesion because of hyperextension capacity, flat articulation, and increased ligamentous laxity. Survival after these kinds of injuries has been more often reported in adults, but are limited in the paediatric population...
March 2015: Cirugia y Cirujanos
Ömer Akar, Can Yaldiz, Nail Özdemir, Onur Yaman, Sedat Dalbayrak
BACKGROUND: Clivus is a bony surface in the posterior cranial fossa, serving as the support of the brainstem and thus neighboring important structures because of its location. Skull base fractures that cannot be shown by conventional radiography can be clearly imaged by high-resolution bone window computed tomography. CASE REPORT: A 44 years-old male referred to the emergency department because of a traffic accident in the car. His only complaint was a severe neckache...
2015: Polish Journal of Radiology
Ravi S Samraj, Erika L Stalets
Longitudinal clivus fractures are rare in children, with only 5 cases published in the English literature to date. Clivus fractures, particularly longitudinal type, are associated with high mortality and morbidity. We report a case of longitudinal clivus fracture in a teenager with survival and complete neurological recovery. Our case is the first pediatric case of longitudinal clivus fracture caused by frontal impact and the first described pediatric case associated with transient diabetes insipidus (DI).
October 2015: Journal of Intensive Care Medicine
Seung-Won Chung, Kyung-Ran Park, Young-Soo Jung, Hyung-Sik Park
LeFort I osteotomy is a standard technique for the surgical correction of dentofacial deformities. Despite its low morbidity, it can lead to various complications at the base of the skull. We report the case of a fractured clivus as an unusual complication.
May 2014: British Journal of Oral & Maxillofacial Surgery
Takao Koiso, Hiroyoshi Akutsu, Shingo Takano, Tetsuya Yamamoto, Eiichi Ishikawa, Yasushi Okoshi, Akira Matsumura
The entity of pituitary (sellar or parasellar) lymphoma includes primary pituitary lymphoma (PPL) and secondary pituitary lymphoma (SPL). The latter has an involvement of systemic lymphoma. Both of these lymphomas are extremely rare. We describe a patient with SPL showing a good prognosis. A 78-year-old woman presented with diplopia, left ptosis, and back pain. Magnetic resonance (MR) imaging revealed a parasellar mass lesion extending to the upper clivus and another mass lesion with compression fracture of the Th3 vertebral body...
2014: Case Reports in Medicine
Paolo Perrini, Nicola Benedetto, Nicola Di Lorenzo
BACKGROUND: The transoral approach allows for an unobstructed anterior view of the craniovertebral junction from the lower clivus to C1 and C2. It can be applied to a heterogeneous spectrum of pathological lesions involving this area including craniovertebral junction malformations, atlanto-axial synovial cysts, pseudoarthrosis following odontoid fractures, selected cases of retro-odontoid pannus, and vertical translocation in rheumatoid patients. METHODS: Microsurgical strategy is dictated by the nature and site of the target lesion...
June 2014: Acta Neurochirurgica
Ulla Perheentupa, Antti A Mäkitie, Jari O Karhu, Petri Koivunen, Roberto Blanco Sequieros, Ilpo Kinnunen
OBJECTIVE: The aim of this study was to develop and test the utility of a novel systematic protocol to analyze CT images of patients with trauma in the anterior cranial base and upper midface. MATERIAL AND METHODS: The radiological data and primary reports of 27 consecutive patients with a frontal skull base fracture treated in two tertiary care hospitals from 2007 to 2011 were scrutinized. A novel algorithm for systematic image reviewing was used to assess the CT images and the findings were compared with the primary radiological reports...
June 2014: Journal of Cranio-maxillo-facial Surgery
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