Document Type : Case Report
Iran University of Medical Sciences
Assistant Professor of Neurosurgery, 7Tir Hospital, Department of neurosurgery, Iran University of Medical Sciences, Tehran, Iran.
Resident of Neurosurgery, 7Tir Hospital, Department of neurosurgery, Iran University of Medical Sciences, Tehran, Iran.
Clival fracture is a rare traumatic injury that usually occurs in patients with high-energy trauma to the head and neck. Here, we present and discuss our experience with a patient with a transverse clival fracture associated with a significant vertical displacement.
A 52 years-old comatose patient was admitted to our emergency department after a high-energy motor vehicle accident. The physical examination demonstrated a Glasgow coma scale (GCS) of 6 (with the motor scale of 4) associated with a left-sided six cranial nerve palsy, a left-sided fixed and dilated pupil; and quadriparesis that was more severe on the right side. The imaging tests revealed the brain contusions, pneumocephalus, and generalized brain edema without local mass effect and midline shift. Also, it showed TCF with a significant vertical displacement and a signal change within the medulla oblongata. The clival fracture was managed in a mild head flexion position without bracing, a routine ICU exchange body positioning program, and the minimum time of supine positioning. The follow-up imaging three months later showed complete bone fusion without any displacement. After 18 months of follow-up, he ambulated, and cranial nerve deficits improved except for mild diplopia due to a remnant of 6 nerve paresis.
Transverse clival fracture, as most of the authors reported, does not need surgical treatment. Bracing can be used in conscious ambulated patients. A mild head-on-neck flexion position associated with suppurative care for bedsores can be a good option for unconscious patients.