Transsphenoidal basilar skull fracture

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Transsphenoidal basilar skull fractures are a particularly serious type of basilar skull fracture usually occurring in the setting of severe traumatic brain injury and with potential for serious complications including damaging the internal carotid arteries and optic nerves as well as high incidence of dural tear with CSF leak. Venous thrombosis complicates up to 31% of these fractures, as many as 75% of caroticocavernous fistulae will have antecedent skull base fractures.

Pathophysiology

Due to the particulars of the anatomy of the base of skull, fractures that involve the sphenoid sinus tend to extend along a number of predefined pathways ^1,23,4:

Anterior transverse

impact: lateral in the region of the temple
coronal fracture plane
- extending from the squamous temporal bone
- through the base of the anterior clinoid processes anterior to the pituitary fossa
- continuing laterally along the contralateral sphenotemporal buttress +/- into squamous temporal bone
may extend inferiorly to involve the pterygoid processes

Lateral frontal diagonal

impact: lateral frontal/anterior malar eminence
oblique fracture plane
- extending from lateral frontal/lateral orbital roof
- through the sphenoid sinus
- though or adjacent to the contralateral carotid canal into sphenopetrosal synchondrosis
- extends as a petrous temporal bone fracture
often associated with maxillary sinus fractures and lateral orbital wall

Posterior transverse

impact: lateral, just anterior to the external acoustic meatus
U-shaped fracture comprised of bilateral longitudinal temporal bone fractures (or mixed) united in the midline by a fracture through the posterior wall of sphenoid/clivus
involves sphenopetrosal synchondrosis, foramen lacerum and carotid canal

Mastoid diagonal

impact: posterolateral in the mastoid region
oblique fracture
- originating in the occipital bone
- extending to the jugular foramen and petro-occipital fissure
- diagonally passing through sphenoid
- into contralateral ethmoid air cells or orbital roof

-<p><strong>Transsphenoidal</strong><strong> basilar skull fractures</strong> are a particularly serious type of <a href="/articles/base-of-skull-fracture">basilar skull fracture</a> usually occurring in the setting of severe <a href="/articles/traumatic-brain-injury">traumatic brain injury</a> and with potential for serious complications including damaging the internal carotid arteries and optic nerves as well as high incidence of dural tear with CSF leak. </p><h4>Pathophysiology</h4><p>Due to the particulars of the anatomy of the <a href="/articles/base-of-the-skull">base of skull</a>, fractures that involve the <a href="/articles/sphenoid-sinus">sphenoid sinus</a> tend to extend along a number of predefined pathways <sup>1,2</sup>:</p><h5>Anterior transverse</h5><ul>
+<p><strong>Transsphenoidal</strong><strong> basilar skull fractures</strong> are a particularly serious type of <a href="/articles/base-of-skull-fracture">basilar skull fracture</a> usually occurring in the setting of severe <a href="/articles/traumatic-brain-injury">traumatic brain injury</a> and with potential for serious complications including damaging the internal carotid arteries and optic nerves as well as high incidence of dural tear with CSF leak. <a title="Cerebral venous thrombosis" href="/articles/cerebral-venous-thrombosis">Venous thrombosis</a> complicates up to 31% of these fractures, as many as 75% of <a title="Caroticocavernous fistula" href="/articles/caroticocavernous-fistula-1">caroticocavernous fistulae</a> will have antecedent skull base fractures. </p><h4>Pathophysiology</h4><p>Due to the particulars of the anatomy of the <a href="/articles/base-of-the-skull">base of skull</a>, fractures that involve the <a href="/articles/sphenoid-sinus">sphenoid sinus</a> tend to extend along a number of predefined pathways <sup>3,4</sup>:</p><h5>Anterior transverse</h5><ul>
~~-<li>extends as a <a href="/articles/temporal-bone-fractures-1">petrous temporal bone fracture</a>~~
+<li>extends as a <a href="/articles/temporal-bone-fracture-1">petrous temporal bone fracture</a>

References changed:

1. Venous Sinus Thrombosis in Blunt Trauma: Incidence and Risk Factors Slasky, Shira E. MD*; Rivaud, Yayone MD*; Suberlak, Matthew MD*; Tairu, Oluwole MD*; Fox, Adam D. MD†; Ohman-Strickland, Pamela PhD‡; Bilinisky, Esther MD, MS* Journal of Computer Assisted Tomography: November/December 2017 - Volume 41 - Issue 6 - p 891–897 doi: 10.1097/RCT.0000000000000620 Neuroradiology
2. Neurologic Emergencies, An Issue of Neurologic Clinics - E-Book By Alireza Minagar, Alejandro A Rabinstein, Elsevier 2012.
3. West OC, Mirvis SE, Shanmuganathan K. Transsphenoid basilar skull fracture: CT patterns. Radiology. 188 (2): 329-38. <a href="https://doi.org/10.1148/radiology.188.2.8327674">doi:10.1148/radiology.188.2.8327674</a> - <a href="https://www.ncbi.nlm.nih.gov/pubmed/8327674">Pubmed</a> <span class="ref_v4"></span>
4. Cantini Ardila JE, Mendoza MÁ, Ortega VG. Sphenoid sinus and sphenoid bone fractures in patients with craniomaxillofacial trauma. Craniomaxillofacial trauma & reconstruction. 6 (3): 179-86. <a href="https://doi.org/10.1055/s-0033-1343778">doi:10.1055/s-0033-1343778</a> - <a href="https://www.ncbi.nlm.nih.gov/pubmed/24436756">Pubmed</a> <span class="ref_v4"></span>
1. West OC, Mirvis SE, Shanmuganathan K. Transsphenoid basilar skull fracture: CT patterns. Radiology. 188 (2): 329-38. <a href="https://doi.org/10.1148/radiology.188.2.8327674">doi:10.1148/radiology.188.2.8327674</a> - <a href="https://www.ncbi.nlm.nih.gov/pubmed/8327674">Pubmed</a> <span class="ref_v4"></span>
2. Cantini Ardila JE, Mendoza MÁ, Ortega VG. Sphenoid sinus and sphenoid bone fractures in patients with craniomaxillofacial trauma. Craniomaxillofacial trauma & reconstruction. 6 (3): 179-86. <a href="https://doi.org/10.1055/s-0033-1343778">doi:10.1055/s-0033-1343778</a> - <a href="https://www.ncbi.nlm.nih.gov/pubmed/24436756">Pubmed</a> <span class="ref_v4"></span>

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