Clival fracture

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.

Epidemiology

Most fractures of the clivus occur in the setting of motor vehicle collisions and falls ^1-5.

Clinical presentation

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 dominates 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

Radiographic features

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. Depending on the CT orientation, the Corradino CT classification for fractures of the clivus is of three types – longitudinal, transverse, and oblique ^1-5. Often investigation of the cervical vessels is necessary ^1-5.

Differential diagnosis

• spheno-occipital synchondrosis
• clival canal