Traumatic Entrapment of the Vertebrobasilar Junction Due to a Longitudinal Clival Fracture: A Case Report

Cho, Joon; Moon, Chang Taek; Kang, Hyun Seung; Choe, Wonyoung; Chang, Sang Keun; Koh, Young Cho; Roh, Hong Gee

doi:10.3346/jkms.2008.23.4.747

Cited by 19 publications

(14 citation statements)

References 15 publications

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“…The main clinical property of traumatic clival epidural, or interdural, is that hematomas are frequently associated with low GCS levels (14,19). Severe injuries, such as, longitudinal clivus fracture, atlantoaxial dislocation, clival dural laceration and entrapment of the vertebrobasilar artery complex have been reported in these patients (5,18,19,24). In trauma cases, it is possible to mechanically peel off the clival dura mater from below to above, by distraction of the dens towards the superior direction.…”

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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“…The mechanism of longitudinal clival fracture has not been fully clarified in children. 3,4,7,12,13) Four pediatric cases of longitudinal clival fracture have been reported in children ranging in age from 9 to 12 years (Table 1). 4,7,12,13) However, inadequate information about the clinical course was provided in two cases.…”

Section: Discussionmentioning

confidence: 99%

“…Traumatic severe brain damage is often discovered in addition to brain stem damage or vascular accident in patients with clivus fracture. 3,7,[12][13][14][15]18) Our case also illustrates the frontal contusion and traumatic subarachnoid hemorrhage which are regarded as the factors which cause the initial unconsciousness after an occiput impact.…”

Section: Discussionmentioning

confidence: 99%

“…14) The incidence was separately reported as 0.55%. 3) A total of 51 cases of fractures of the clivus due to head injury have been reported, mostly in adults who suffered serious vascular and cranial nerve damage. [1][2][3][4][5][7][8][9][10][11][12][13][14][15][16][17][18] Longitudinal clival fractures were identified in 29 cases, including four in children.…”

Section: Introductionmentioning

confidence: 99%

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Traumatic Longitudinal Clival Fracture in a Child -Case Report-

Ono

Uchida

Tanaka

et al. 2011

Neurol. Med. Chir.(Tokyo)

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A 7-year-old boy presented with a longitudinal clival fracture following a traffic accident. The boy presented only with temporary unconsciousness despite suffering a fracture of the clivus. Fractures of the clivus are often caused by severe head trauma, and the mortality rate is high due to coexisting injury of the adjacent vessels, brain stem, and lower cranial nerves. Review of the radiological and clinical findings of longitudinal clival fractures found that all reported pediatric patients with longitudinal clival fracture, including the present case, suffered an occipital impact, whereas the majority of longitudinal clival fractures in adults occur following frontal or axial impact.

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“…Despite the poor prognosis due to posterior circulation infarction, 1) the diagnosis is difficult in most cases and appropriate treatment has not been established. 2 , 3) …”

Section: Introductionmentioning

confidence: 99%

Endovascular Intervention in Basilar Artery Entrapment within the Longitudinal Clivus Fracture: A Case Report

Kanamori

Yamanouchi

Kano

et al. 2018

Neurol. Med. Chir.(Tokyo)

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Although vascular complications after head trauma is well recognized, basilar artery entrapment within the longitudinal clivus fracture is rare. A 69-year-old man presented with progressive disturbance of consciousness and right hemiplegia after trauma. Computed tomography scan showed a right-sided acute subdural hematoma and multiple skull fractures, including a longitudinal clivus fracture. Magnetic resonance imaging revealed basilar artery occlusion and a small infarction at the ventral part of the pons. On the assumption of acute arterial occlusion caused by thrombus, endovascular thrombectomy was attempted, but resulted in perforation. After the procedure, basilar artery entrapment within the longitudinal clivus fracture turned out to be the cause of the occlusion. The present case suggests that basilar artery entrapment within the longitudinal clivus fracture is a possible cause of neurological deficits after trauma. In this subset, endovascular intervention without a correct diagnosis of this phenomenon is high risk.

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Traumatic Entrapment of the Vertebrobasilar Junction Due to a Longitudinal Clival Fracture: A Case Report

Cited by 19 publications

References 15 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.

Traumatic Longitudinal Clival Fracture in a Child -Case Report-

Endovascular Intervention in Basilar Artery Entrapment within the Longitudinal Clivus Fracture: A Case Report

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