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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.
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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 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
Clival fractures are rarely evident on plain radiographs 1-4.
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.
- 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
- 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
- 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
- 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
- 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