Citation, DOI, disclosures and article data
Citation:
Neto A, Hacking C, Luong D, et al. Clival fracture. Reference article, Radiopaedia.org (Accessed on 25 Apr 2024) https://doi.org/10.53347/rID-98280
Disclosures:
At the time the article was last revised Craig Hacking had the following disclosures:
- Philips Australia, Paid speaker at Philips Spectral CT events (ongoing)
These were assessed during peer review and were determined to
not be relevant to the changes that were made.
View Craig Hacking's current disclosures
Clival fractures are uncommon skull base fractures resulting from high-energy cranial trauma and are usually associated with other skull vault fractures and brain injuries.
For a general discussion, please refer to the article on basilar fractures of the skull.
Most fractures of the clivus occur in the setting of motor vehicle collisions and falls 1-5.
Fractures of the clivus occur due to severe head injury and are often associated with 1-5:
other cranial fractures
cervical spine fractures
intracranial hemorrhages, which dominate the clinical presentation
bilateral abducens nerve palsies due to proximity to Dorello canal
other cranial nerve deficits, including II, III, IV, V, VI, VII, VIII, IX, and XI
CSF fistula
pituitary dysfunction
multisystem trauma
Plain radiograph
Clival fractures are rarely evident on plain radiographs 1-4.
CT
CT with bone windows settings is the modality of choice to identify fractures of the clivus 1-5. Fracture orientation determines three types according to the Corradino CT classification (in decreasing frequency) 1-6:
oblique
longitudinal
transverse
Often investigation of the cervical vessels is necessary 1-5. Rarely the longitudinal type can be associated with entrapment of the vertebral or basilar artery 6, which unsurprisingly carries the worst prognosis 1.
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1. Menkü A, Koç R, Tucer B, Durak A, Akdemir H. Clivus Fractures: Clinical Presentations and Courses. Neurosurg Rev. 2004;27(3):194-8. doi:10.1007/s10143-004-0320-2 - Pubmed
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2. Ochalski P, Spiro R, Fabio A, Kassam A, Okonkwo D. Fractures of the Clivus: A Contemporary Series in the Computed Tomography Era. Neurosurgery. 2009;65(6):1063-9; discussion 1069. doi:10.1227/01.NEU.0000360154.18604.28 - Pubmed
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3. Evers J, Vieth V, Hartensuer R, Raschke M, Vordemvenne T. Management of an Extended Clivus Fracture: A Case Report. BMC Res Notes. 2013;6(1):554. doi:10.1186/1756-0500-6-554 - Pubmed
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4. Winkler-Schwartz A, Correa J, Marcoux J. Clival Fractures in a Level I Trauma Center. J Neurosurg. 2015;122(1):227-35. doi:10.3171/2014.9.JNS14245 - Pubmed
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5. Dreizin D, Sakai O, Champ K et al. CT of Skull Base Fractures: Classification Systems, Complications, and Management. Radiographics. 2021;41(3):762-82. doi:10.1148/rg.2021200189 - Pubmed
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6. Garland J, Watkins T, Craigie M, Milne N, Ong B. Basilar Artery Impingement Secondary to Longitudinal Fracture of the Clivus: A Rare Entity with Postmortem Computed Tomography Angiogram Correlation. Forensic Imaging. 2023;35:200564. doi:10.1016/j.fri.2023.200564
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