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刘 夏, 郑 吉龙. [Not Available]. FA YI XUE ZA ZHI 2021; 37:716-717. [PMID: 35191242 DOI: 10.12116/j.issn.1004-5619.2020.400204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
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Fromm J, Meuwly E, Wendling-Keim D, Lehner M, Kammer B. Clival fractures in children: a challenge in the trauma room setting! Childs Nerv Syst 2021; 37:1199-1208. [PMID: 33245407 DOI: 10.1007/s00381-020-04963-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2020] [Accepted: 11/04/2020] [Indexed: 10/22/2022]
Abstract
OBJECTIVE A clival fracture is a rare but life-threatening traumatic brain injury in the adult and pediatric populations. To date, there are very few conclusive recommendations in the literature concerning the diagnosis and treatment of pediatric clival fractures. METHODS In 2014 and 2015, two pediatric patients with severe blunt head trauma and clival fractures were evaluated and treated at a level I trauma center. Both cases are documented and supplemented by an extensive review of the literature focusing on the diagnostic workup, classification, and clinical course of clival fractures in children. RESULTS The clinical course of two children (8 and 9 years old) with clival fractures in concert with other intra- and extracranial injuries was analyzed. A total of 17 papers encompassing 37 patients (age range, 1-18 years) were included for a systematic review. The literature review revealed a mortality rate of 23% in pediatric patients with a clival fracture. Over 50% of the patients presented with cranial nerve damage, and two-thirds suffered from intracranial vascular damage or intracerebral bleeding. CONCLUSIONS Clival fractures are a very rare but severe consequence of blunt head trauma in the pediatric population and may be challenging to diagnose, especially in cases with an unfused sphenooccipital synchondrosis. Vascular damage following clival fractures appears to be as common in pediatric patients as in adults. Therefore, contrast-enhanced CT of the cervical spine and head and/or magnetic resonance angiography is strongly recommended to rule out vascular injury of the extra- and intracranial brain-supplying vessels within the trauma room setting.
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Affiliation(s)
- Julian Fromm
- Department of Pediatric Surgery, Dr. von Hauner Children's Hospital, Ludwig-Maximilians-University of Munich, Lindwurmstr. 4, 80337, Munich, Germany
| | - Eliane Meuwly
- Department of Pediatric Surgery, Children's Hospital Lucerne, Luzerner Kantonsspital, Spitalstrasse 20, 6000, Lucerne 16, Switzerland
| | - Danielle Wendling-Keim
- Department of Pediatric Surgery, Dr. von Hauner Children's Hospital, Ludwig-Maximilians-University of Munich, Lindwurmstr. 4, 80337, Munich, Germany
| | - Markus Lehner
- Department of Pediatric Surgery, Dr. von Hauner Children's Hospital, Ludwig-Maximilians-University of Munich, Lindwurmstr. 4, 80337, Munich, Germany. .,Department of Pediatric Surgery, Children's Hospital Lucerne, Luzerner Kantonsspital, Spitalstrasse 20, 6000, Lucerne 16, Switzerland.
| | - Birgit Kammer
- Pediatric Radiology, Department of Clinical Radiology, Ludwig-Maximilians-University Munich, Lindwurmstr. 4, 80337, Munich, Germany
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Moscote-Salazar L, Garcia-Ballestas E, Agrawal A. Clivus fracture and entrapment of the basilar artery. Neurochirurgie 2020; 66:63. [DOI: 10.1016/j.neuchi.2019.10.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Revised: 09/27/2019] [Accepted: 10/11/2019] [Indexed: 11/26/2022]
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Jelodar S, Pourrashidi A, Amirjamshidi A. Uncomplicated Wide Oblique Clivus Fracture, the First Case to be Included in the List of Classification; Report of the Case and Review of Literature. Bull Emerg Trauma 2019; 7:416-419. [PMID: 31858006 PMCID: PMC6911711 DOI: 10.29252/beat-070412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Sheno-occipital diastasis happens more frequently in children and is accompanied with neural and vascular injuries leading to a high rate of mortality. We present a rare type of clival fracture in a 21 years old man who could survive without any deficit even though the fracture extended widely from left Asterion to the right orbit accompanied by widespread damage of the skull base air sinuses in 3D CT scan. To the best knowledge of the authors, neither this type of fracture, nor the clinical presentation, has been reported in relevant literature.
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Affiliation(s)
- Sina Jelodar
- Department of Neurosurgery, Sina Hospital, Emam Ave. Tehran University of Medical Sciences, Tehran, Iran
| | - Ahmad Pourrashidi
- Department of Neurosurgery, Sina Hospital, Emam Ave. Tehran University of Medical Sciences, Tehran, Iran
| | - Abbas Amirjamshidi
- Department of Neurosurgery, Sina Hospital, Emam Ave. Tehran University of Medical Sciences, Tehran, Iran
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Faraji AH, Ochalski PG, Ozpinar A, Blatt JE, Pollack IF. Isolated Traumatic Diastasis of the Clival Synchondroses without Clival Fracture. Pediatr Neurosurg 2018; 53:270-274. [PMID: 29672322 DOI: 10.1159/000488058] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2017] [Accepted: 02/26/2018] [Indexed: 12/22/2022]
Abstract
Traumatic clival fractures in the pediatric population are associated with high mortality rates. In our previously reported series, a subset of clival fractures were associated with traumatic diastasis of the surrounding clival synchondroses. Herein, we describe a pediatric case of an isolated traumatic diastasis of the clival synchondroses without clival fracture with significant injury to neurovascular structures. To our knowledge this is the first report to describe this entity. Careful radiological attention should be made towards the clival synchondroses in crushing head injuries to best tailor screening for cerebrovascular injury even in the absence of clival fractures.
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Affiliation(s)
- Amir H Faraji
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA.,Children's Hospital of Pittsburgh of UPMC, Pittsburgh, Pennsylvania, USA
| | | | - Alp Ozpinar
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA.,Children's Hospital of Pittsburgh of UPMC, Pittsburgh, Pennsylvania, USA
| | - Jason E Blatt
- Department of Neurological Surgery, University of Florida, Gainesville, Florida, USA
| | - Ian F Pollack
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA.,Children's Hospital of Pittsburgh of UPMC, Pittsburgh, Pennsylvania, USA
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Sim SY, Kim HG, Yoon SH, Choi JW, Cho SM, Choi MS. Reappraisal of Pediatric Diastatic Skull Fractures in the 3-Dimensional CT Era: Clinical Characteristics and Comparison of Diagnostic Accuracy of Simple Skull X-Ray, 2-Dimensional CT, and 3-Dimensional CT. World Neurosurg 2017; 108:399-406. [DOI: 10.1016/j.wneu.2017.08.107] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2017] [Revised: 08/14/2017] [Accepted: 08/16/2017] [Indexed: 11/16/2022]
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Walker A, Dos Santos MP, Glikstein R, Michaud J. Fatal Entrapment of the Basilar Artery in a Longitudinal Fracture of the Clivus Due to Head Injury: A Case Report and Review of the Literature. Acad Forensic Pathol 2017; 7:453-468. [PMID: 31239994 DOI: 10.23907/2017.038] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 05/08/2017] [Accepted: 06/26/2017] [Indexed: 11/12/2022]
Abstract
Infarction of the posterior cerebral artery circulation arising from entrapment of the basilar artery in a fracture of the clivus has been reported in the medical literature, predominantly in the radiology and emergency medicine journals. Review of the medical literature on the topic revealed 14 published cases of entrapment of the basilar and/or vertebral artery within a longitudinal fracture of the clivus. These were all reported between 1964 and 2016 and postmortem examination had been conducted on seven cases. To date, no case of entrapment of the basilar and/or vertebral artery in a fracture of the clivus has been reported in the forensic pathology literature, and the published literature on the entity is reviewed.
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Affiliation(s)
- Alfredo Walker
- Eastern Ontario Regional Forensic Pathology Unit - Department of Pathology and Laboratory Medicine - University of Ottawa
| | | | - Rafael Glikstein
- Ottawa Hospital - Department of Medical Imaging - Section of Diagnostic and Interventional Neuroradiology
| | - Jean Michaud
- Ottawa Hospital - Department of Pathology and Laboratory Medicine
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Stephens JR, Holmes S, Evans BT. Applied anatomy of the anterior cranial fossa: what can fracture patterns tell us? Int J Oral Maxillofac Surg 2015; 45:275-8. [PMID: 26589135 DOI: 10.1016/j.ijom.2015.10.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2015] [Accepted: 10/01/2015] [Indexed: 11/29/2022]
Abstract
The skull base is uniquely placed to absorb anteriorly directed forces imparted either via the midfacial skeleton or cranial vault. A variety of skull base fracture classifications exist. Less well understood, however, is fracture extension beyond the anterior cranial fossa (ACF) into the middle and posterior cranial fossae. The cases of 81 patients from two UK major trauma centres were studied to examine the distribution of fractures across the skull base and any relationship between the vector of force and extent of skull base injury. It was found that predominantly lateral force to the craniofacial skeleton produced a fracture that propagated beyond the ACF into the middle cranial fossa in 77.4% of cases, significantly more (P<0.001) than for predominantly anterior force (12.0%). Fractures were significantly more likely to propagate into the posterior fossa with a lateral vector of impact compared to an anterior vector (P=0.049). This difference in energy transfer across the skull base may, in part, be explained by the local anatomy. The more delicate central ACF acts as a 'crumple zone' in order to absorb force. Conversely, no collapsible interface exists in the lateral aspect of the ACF, thus the lateral ACF behaves like a 'buttress', resulting in increased energy transfer.
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Affiliation(s)
- J R Stephens
- The Craniofacial Trauma Research Group, Queen Mary University London, London, UK; Faculty of Medicine, University of Southampton, University Hospital Southampton, Southampton, UK.
| | - S Holmes
- The Craniofacial Trauma Research Group, Queen Mary University London, London, UK; Department of Oral and Maxillofacial Surgery, The Royal London Hospital, Whitechapel, London, UK
| | - B T Evans
- The Craniofacial Trauma Research Group, Queen Mary University London, London, UK; Department of Oral and Maxillofacial Surgery, University Hospital Southampton, Southampton, UK
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Akar Ö, Yaldiz C, Özdemir N, Yaman O, Dalbayrak S. Isolated Transverse Clivus Fracture without Neurodeficit: Case Report and Review of Literature. Pol J Radiol 2015; 80:151-4. [PMID: 25848439 PMCID: PMC4370353 DOI: 10.12659/pjr.893027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2014] [Accepted: 11/27/2014] [Indexed: 11/09/2022] Open
Abstract
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. His X-ray examination showed no pathology. The computed tomographic examination showed no parenchymal pathology, but a isolated transverse fracture in the clivus. CONCLUSIONS The computed tomographic examination showed isolated transverse fracture in the clivus our case presented in this paper is the first case of transverse clivus fracture without additional cranial bone fracture and neurologic deficit in the literature.
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Affiliation(s)
- Ömer Akar
- Department of Neurosurgery, Necip Fazıl State Hospital, Kahramanmaras, Turkey
| | - Can Yaldiz
- Departmant of Neurosurgery, Sakarya University Training and Research Hospital, Sakarya, Turkey
| | - Nail Özdemir
- Clinic of Neurosurgery, Specialist in Neurosurgery, Tepecik Education and Training Hospital, İzmir, Turkey
| | - Onur Yaman
- Department of Neurosurgery, University of Koç, Istanbul, Turkey
| | - Sedat Dalbayrak
- Department of Neurosurgery, Neurospinal Academy, Istanbul, Turkey
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Winkler-Schwartz A, Correa JA, Marcoux J. Clival fractures in a Level I trauma center. J Neurosurg 2015; 122:227-35. [DOI: 10.3171/2014.9.jns14245] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT
Clival fracture (CF) is rare among head traumas. The aim of this study was to explore how radiological features observed in CF reflect the clinical picture and mechanism of injury in such cases.
METHODS
Radiological data for patients with skull base fracture admitted to the Montreal General Hospital between February 2002 and October 2012 were obtained from the Quebec Trauma Registry and reviewed for CF. Identified CF was categorized by orientation and quality. Injury mechanism, clinical presentation, and follow-up outcome were obtained through retrospective chart review.
RESULTS
Of the 1738 patients with skull base fractures, 65 exhibited CF, representing 1.2% of the 5416 patients with traumatic brain injuries admitted during the period studied. Thirty-nine (60%) of the 65 CFs were obliquely oriented, 17 (26.2%) were longitudinal, and 9 (14%) were transverse. Twenty-nine (45%) of the 65 patients demonstrated linear fracture, 17 (26%) hairline, 10 (15%) diastatic, and 9 (14%) displaced. Cranial nerve deficits and vascular injury occurred in 13.8% and 7.7% of cases, respectively. Twenty-five patients (38.5%) died in hospital. The long-term Extended Glasgow Outcome Scale score was significantly lower in transverse compared with longitudinal and oblique fractures (p = 0.03 and 0.03, respectively) and lower in diastatic compared with displaced fractures (p = 0.05).
CONCLUSIONS
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.
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Affiliation(s)
| | | | - Judith Marcoux
- Departments of 1Neurology and Neurosurgery and
- 3Department of Neurosurgery, McGill University Health Centre, Montreal, Quebec, Canada
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Lee TS, Kellman R, Darling A. Crumple zone effect of nasal cavity and paranasal sinuses on posterior cranial fossa. Laryngoscope 2014; 124:2241-6. [PMID: 24515980 DOI: 10.1002/lary.24644] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2013] [Revised: 01/21/2014] [Accepted: 02/03/2014] [Indexed: 12/25/2022]
Abstract
OBJECTIVES/HYPOTHESIS Examine a protective crumple zone effect of paranasal sinuses and nasal cavity on skull base fractures. STUDY DESIGN Randomized-control, cadaveric study. METHODS In the experimental group (n = 4), the nasal cavity and bilateral sinuses of cadavers were obliterated with bone cement, whereas the control group (n = 4) had native sinus architecture. Increasing frontal, glabellar impacts were introduced. Each impact event was examined with a high-speed video camera and sphenoid sinus pressure sensor. After each impact, computed tomography scans were performed and fracture sites were analyzed. RESULTS The control group with intact sinuses showed statistically longer time duration, during which kinetic energy transfer occurred, and longer sphenoid wall pressure equilibrium time after an impact (P < 0.05). In the experimental group, there were statistically higher fracture incidences of clivus, petrous portion of internal carotid, occipital bone, and foramen magnum (P < 0.05). The type A pattern (n = 6) had anterior skull base failure occurring before posterior skull base failure. Type B pattern (n = 2), seen only in two experimental specimens, is marked by premature posterior skull base collapse occurring before anterior skull base failure with grossly disrupted posterior cranial fossa structures. CONCLUSION The presence of nasal cavity and paranasal sinuses behaves as a crumple zone to protect the cranial structures, preferentially posterior cranial fossa. Obliteration of the nasal cavity and paranasal sinuses with bone cement significantly increased structural tolerance of the anterior cranial vault to frontal, glabellar impacts at the cost of premature, posterior cranial fossa failure.
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Affiliation(s)
- Thomas S Lee
- Department of Otolaryngology, Virginia Commonwealth University, Richmond, Virginia
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López-Guerrero AL, Martínez-Lage JF, González-Tortosa J, Almagro MJ, García-Martínez S, Reyes SB. Pediatric crushing head injury: biomechanics and clinical features of an uncommon type of craniocerebral trauma. Childs Nerv Syst 2012; 28:2033-40. [PMID: 22832790 DOI: 10.1007/s00381-012-1864-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2012] [Accepted: 07/10/2012] [Indexed: 11/30/2022]
Abstract
BACKGROUND Head injuries constitute one of the leading causes of pediatric morbidity and mortality. Most injuries result from accidents involving an acceleration/deceleration mechanism. However, a special type of head injury occurs when the children sustain a traumatism whose main component is a static load in relation to a crushing mechanism with the head relatively immobile. PATIENTS AND METHODS We report a series of children who sustained a craniocerebral injury of variable severity produced by head crushing. We also analyze epidemiological and clinical data, and biomechanics in these injuries. RESULTS Mean age of the group (13 boys/6 girls) was 4.1 years. All patients showed external lesions (scalp wounds or hemorrhage from the nose, ears, or throat). Eleven children were initially unconscious. Six children presented cranial nerve deficits in addition to impaired hearing. Skull base fractures were seen in most cases with extension to the vault in 11 instances. Fourteen patients had an associated intracranial lesion, including two with diffuse axonal injury. Surgery was performed in three instances. Only seven patients were left with sequelae. DISCUSSION AND CONCLUSIONS The observed skull, brain, and cranial nerve lesions corresponded to a mechanism of bilateral compression of the children's heads mainly occasioned by a static load, although an associated component of dynamic forces was also involved. The skull and its covering and the cranial nerves were the most severely affected structures while the brain seemed to be relatively well preserved. Most crush injuries appear to be preventable by the appropriate supervision of the children.
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Affiliation(s)
- Antonio López López-Guerrero
- Unit of Pediatric Neurosurgery and Regional Service of Neurosurgery, Virgen de Arrixaca University Hospital, 30120 El Palmar, Murcia, Spain
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