Highlights:
- •The clival fracture is an infrequent pathology.
- •The least common subtype is the transverse one which has the highest mortality rate.
- •The fracture displacement is extremely rare.
- •Their treatment is poorly defined because of the paucity of cases.
- •We described one case treated by occipitocervical fusion C0-C3 with excellent outcome at six months (Modified Rankin Scale 0).
Abbreviations:
VI CN (Sixth Cranial nerve), CT (Computed tomography)The clival fracture is an infrequent pathology (<1% of cranial trauma)[
[1]
], the least common subtype is the transverse (14,6%)2 but its mortality is > 66 %[1
, 2
] due to intracranial vessels, cranial nerves or brainstem injuries[2
, 3
]. Moreover, the fracture displacement is extremely rare (14 %)1. This 55-years-old man presented cranial trauma after diving into shallow water, on initial examination he had 15/15 in Glasgow Coma Scale, right sixth cranial nerve (VI CN) palsy, dysphagia and right hemiparesis. An urgent computed tomography (CT) revealed an isolated displaced transverse clival fracture as it is showed in the sagittal image (Fig. 1A, white arrow) and three-dimensional CT angiography reconstruction (Fig. 1B, black arrows). Prior informed consent, the treatment of this dramatic fracture was occipitocervical fusion C0-C3 to stabilize the fracture and avoid the neurological deficit progression. A postoperative magnetic resonance imaging scan was made which showed clival deformity (Fig. 2 A and B, white arrow), integrity in the right VI CN in the cisternal segment (Fig. 2 A and B, dashed white arrow) and absence of brainstem compression; He was completely recovered at 6 months (Modified Rankin Scale: 0) which could be justified because of the absence of structural damage in cranial nerves and brainstem[[4]
].
Disclosure of Funding: None.
Competing interests: None.
Permission from patient obtained in writing for publishing their case report: Yes.
References:
- Clival fractures in a Level I trauma center.J Neurosurg. 2015; 122: 227-235https://doi.org/10.3171/2014.9.JNS14245
- Fractures of the clivus: a comtemporary series in the computed tomography era.Neurosurgery. 2009; 65: 1063-1069
- Transverse clival fracture associated with bilateral petrous fractures extending through the occipital bone.J Neurosurg. 2013; 118: 775
- A Case Report of Bilateral Abducens Palsy in the Setting of Clival Fracture-Recovery Related to Pathophysiological Basis of Injury.Neuroofthalmology. 2021; 45: 343-346https://doi.org/10.1080/01658107.2020.1831549
Article info
Publication history
Accepted:
February 8,
2023
Received:
November 21,
2022
Identification
Copyright
© 2023 Elsevier Ltd. All rights reserved.
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