Traumatic clival subdural hematoma in an adult

Casey, David; Chaudhary, Bedansh Roy; Leach, Philip; Herwadkar, Amit; Karabatsou, Konstantina

doi:10.3171/2008.9.jns17651

Cited by 27 publications

(22 citation statements)

References 11 publications

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“…Casey et al (3) have recently distinguished the clival hematomas as either epidural or subdural; and accomplished this classification by taking into account the tectorial membrane as the gauge. According to Casey's (3) classification, an epidural clival hematoma does not extend beyond the tectorial membrane, whereas a subdural clival hematoma may lead into the spinal subarachnoid space.…”

Section: Discussionmentioning

confidence: 99%

Subarachnoid, subdural and interdural spaces at the clival region: an anatomical study.

Ayberk¹,

Özveren²,

Aslan³

et al. 2011

Turkish Neurosurgery

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AIm:We aimed to show the significance of the anterior pontine membrane as a determining structure between the subdural and subarachnoid space in the clival region. mAterIAl and methOds: Five adult cadaver heads and five cerebral hemispheres were used. The skull vault and hemipheres were removed by sectioning through the pontomesencephalic junction. Five other heads hemispheres were removed but the arachnoid membrane was protected and the cerebral side of the clival dura mater was dissected. In another specimen, the dural porus of the abducens nerve was sectioned for histological evaluation. Three cases of hematoma at the clivus were presented to support our findings. results:The anterior pontine membrane is the arachnoid membrane forming the anterior wall of the prepontine cistern with its lateral extension at the skull base. This membrane forms the subdural and subarachnoid spaces by forming a barrier between the clival dura mater and neurovascular structures of the brainstem. There were rigid fibrous trabeculations between both cerebral and periosteal dural layers forming the basilar plexus as the interdural space in the clivus. COnClusIOn:The anterior pontine membrane separates the subdural and subarachnoid spaces at the clival region. The hematomas of the clival region require to be evaluated with consideration given to the existance of the subdural space.KeywOrds: Anterior pontine membrane, Arachnoid, Clivus, Interdural space ÖZ AmAÇ: Bu çalışmada, klival bölgedeki subdural ve subaraknoid mesafenin belirlenmesinde anterior pontin membranın önemini göstermek istedik. yÖntem ve GereÇ: Çalışmada beş yetişkin kadavranın kafatası ve beş serebral hemisfer kullanılmıştır. Kafatası ve hemisferler pontomezensefalik bileşke boyunca kesilerek çıkarılmıştır. Diğer beş hemisfer, araknoid membran korunarak çıkarılmış ve klival duramaterin serebral kısmı diseke edilmiştir. Bir başka spesmende, abdusens siniri dural porusu civarında histolojik kesit almak için kesilmiştir. Bulguları desteklemek için üç klival hematom vakası sunulmuştur.BulGulAr: Anterior pontin membran, prepontin sisternin anterior duvarını oluşturur ve kafa kaidesinin lateraline doğru uzanır. Bu membran, beyin sapının nörovaskuler yapıları ve klival dura dura mater arasında bariyer oluşturarak, subdural ve subaraknoid mesafenin oluşmasını sağlar. Klivusta baziler pleksusu oluşturan serebral ve periostal dural tabakalar arasında rijit fibröz trabekülasyonlar vardı. sOnuÇ: Anterior pontin membran, klival bölgede subdural ve subaraknoid mesafeleri ayırır. Klival bölgedeki hematomların, subdural mesafenin varlığı göz önüne alınarak değerlendirilmesi gerekir.

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Section: Discussionmentioning

confidence: 99%

Subarachnoid, subdural and interdural spaces at the clival region: an anatomical study.

Ayberk¹,

Özveren²,

Aslan³

et al. 2011

Turkish Neurosurgery

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“…Todos se deben a eventos traumáticos y todos son epidurales excepto un caso que es subdural 1,[3][4][5][7][8][9][10][11][12][13][14][16][17][18]20,21 . Coincidiendo con el mecanismo de formación también observamos que es una entidad casi exclusiva de la edad pediátrica.…”

Section: Discussionunclassified

Paresia VI par craneal por hematoma subdural retroclival y espinal postraumático: presentación de un caso y revisión de la literatura

et al. 2011

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ResumenIntroducción. Los hematomas retroclivales postraumáticos son extremadamente infrecuentes y casi exclusivos de la edad pediátrica. Únicamente se ha documentado en la literatura un caso de hematoma subdural retroclival postraumático.Caso clínico. Varón de 8 años de edad que tras accidente de bicicleta sufre traumatismo cráneo-encefálico con hiperextensión cervical. A su ingreso presentó Glasgow inicial de 13 y diplopia por paresia del VI par derecho. En la TAC y RM cráneo-cervical se objetivó un hematoma subdural retroclival. Se realizó manejo conservador con colocación de collarín rígido. Se observó recuperación espontánea del VI par a los 6 días presentando únicamente cervicalgia al alta. Presentó resolución clínica y radiológica a los 3 meses del accidente.Conclusión. Las lesiones hemorrágicas retroclivales postraumáticas son típicas de la edad pediátrica por la inmadurez de la unión cráneo-cervical que presentan. El tratamiento de elección es la colocación de un collarín rígido aunque si existe progresión clínica puede ser necesaria la evacuación quirúrgica.PALABRAS CLAVE. Hematoma retroclival. Epidural. Subdural. Traumatismo cráneo-encefálico. Paresia abducens.Abducens nerve palsy due to postraumatic retroclival and spinal subdural hematoma: case report and literature review Summary

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“…Presence of a retroclival or subdural hematoma at the CVJ can be indicative of an occult CVJ injury. 5,17 Given clinical suspicion for spinal cord injury or ligamentous instability, subsequent MRI was performed and revealed increased fluid in the C1-2 facet joints with intact cruciate ligaments (Fig. 6).…”

Section: Resultsmentioning

confidence: 99%

Magnetic resonance imaging of traumatic injury to the craniovertebral junction: a case-based review

Roy¹,

Miller²,

Holland³

et al. 2015

FOC

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OBJECT The craniovertebral junction (CVJ) is unique in the spinal column regarding the degree of multiplanar mobility allowed by its bony articulations. A network of ligamentous attachments provides stability to this junction. Although ligamentous injury can be inferred on CT scans through the utilization of craniometric measurements, the disruption of these ligaments can only be visualized directly with MRI. Here, the authors review the current literature on MRI evaluation of the CVJ following trauma and present several illustrative cases to highlight the utility and limitations of craniometric measures in the context of ligamentous injury at the CVJ. METHODS A retrospective case review was conducted to identify patients with cervical spine trauma who underwent cervical MRI and subsequently required occipitocervical or atlantoaxial fusion. Craniometric measurements were performed on the CT images in these cases. An extensive PubMed/MEDLINE literature search was conducted to identify publications regarding the use of MRI in the evaluation of patients with CVJ trauma. RESULTS The authors identified 8 cases in which cervical MRI was performed prior to operative stabilization of the CVJ. Craniometric measures did not reliably rule out ligamentous injury, and there was significant heterogeneity in the reliability of different craniometric measurements. A review of the literature revealed several case series and descriptive studies addressing MRI in CVJ trauma. Three papers reported the inadequacy of the historical Traynelis system for identifying atlantooccipital dislocation and presented 3 alternative classification schemes with emphasis on MRI findings. CONCLUSIONS Recognition of ligamentous instability at the CVJ is critical in directing clinical decision making regarding surgical stabilization. Craniometric measures appear unreliable, and CT alone is unable to provide direct visualization of ligamentous injury. Therefore, while the decision to obtain MR images in CVJ trauma is largely based on clinical judgment with craniometric measures used as an adjunct, a high degree of suspicion is warranted in the care of these patients as a missed ligamentous injury can have devastating consequences.

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Traumatic clival subdural hematoma in an adult

Cited by 27 publications

References 11 publications

Subarachnoid, subdural and interdural spaces at the clival region: an anatomical study.

Subarachnoid, subdural and interdural spaces at the clival region: an anatomical study.

Paresia VI par craneal por hematoma subdural retroclival y espinal postraumático: presentación de un caso y revisión de la literatura

Magnetic resonance imaging of traumatic injury to the craniovertebral junction: a case-based review

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