J Korean Med Sci.  2008 Aug;23(4):747-751. 10.3346/jkms.2008.23.4.747.

Traumatic Entrapment of the Vertebrobasilar Junction Due to a Longitudinal Clival Fracture: A Case Report

• Cho J
• Moon CT
• Kang HS
• Choe WJ
• Chang SK
• Koh YC
• Roh HG

• KMID: 1785844
• DOI: http://doi.org/10.3346/jkms.2008.23.4.747

Abstract

Vertebrobasilar junction entrapment due to a clivus fracture is a rare clinical observation. The present case report describes a 54-yr-old man who sustained a major craniofacial injury. The patient displayed a stuporous mental state (Glasgow Coma Scale [GCS]=8) and left hemiparesis (Grade 3). The initial computed tomography (CT) scan revealed a right subdural hemorrhage in the frontotemporal region, with a midline shift and longitudinal clival fracture. A decompressive craniectomy with removal of the hematoma was performed. Two days after surgery, a follow-up CT scan showed cerebellar and brain stem infarction, and a CT angiogram revealed occlusion of the left vertebral artery and entrapment of vertebrobasilar junction by the clival fracture. A decompressive suboccipital craniectomy was performed and the patient gradually recovered. This appears to be a rare case of traumatic vertebrobasilar junction entrapment due to a longitudinal clival fracture, including a cerebellar infarction caused by a left vertebral artery occlusion. A literature review is provided.

Keyword

Cranial Fossa, Posterior; Skull Fracture, Basilar; Vertebral artery; Brain Infarction

MeSH Terms

Basilar Artery/*injuries
Humans
Male
Middle Aged
Skull Fractures/*complications/radiography
Tomography, X-Ray Computed
Vertebral Artery/*injuries

Figure

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  Fig. 1 Initial CT scan showing a longitudinal clivus fracture extending from the frontal basal skull fracture (A), and an acute subdural hemorrhage with a partial midline shift in the right frontotemporal region (B).

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  Fig. 2 Follow-up CT scan showing a left cerebellar and brain stem infarction.

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  Fig. 3 CT angiogram (A) and its source images (B). White arrows indicate the right vertebral artery (a), entrapped vertebrobasilar junction (b, c) and basilar artery (d, e).

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  Fig. 4 Transfemoral conventional left vertebral angiogram anteroposterior (A) and lateral (B) views. Arrows show the vertebral artery obstruction in the cervical region.

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  Fig. 5 Post-surgical CT scan showing the decompressive suboccipital craniectomy state.

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