Computed Tomography and Magnetic Resonance Imaging of a Basilar Artery Herniation into the Sphenoid Sinus

ABSTRACT

We report a rare case of herniation of a basilar artery into the sphenoid sinus after a traumatic skull base fracture. Computed tomographic angiography, magnetic resonance imaging, and cerebral angiogram demonstrated patency of the basilar artery through the fractured clivus at the time of injury, a very rare occurrence. The following day, the patient developed pontine and cerebellar infarcts. In a patient with clival fracture, we advocate fast assessment of vertebrobasilar system with CTA and early anticoagulation treatment in those with vascular entrapment.

Basilar artery - herniation - clivus - fracture - CT - MR

REFERENCES

• 1 Bala A, Knuckey N, Wong G, Lee G YF. Longitudinal clivus fracture associated with trapped basilar artery: unusual survival with good neurological recovery.  J Clin Neurosci. 2004;  11 660-663
• 2 Corradino G, Wolf A L, Mirvis S, Joslyn J. Fractures of the clivus: classification and clinical features.  Neurosurgery. 1990;  27 592-596
• 3 Kapila A, Chakeres D W. Clivus fracture: CT demonstration.  J Comput Assist Tomogr. 1985;  9 1142-1144
• 4 Sanders B B, VanderArk G D. Transverse fracture of the clivus.  J Neurosurg. 1973;  39 610-614
• 5 Joslyn J N, Mirvis S E, Markowitz B. Complex fractures of the clivus: diagnosis with CT and clinical outcome in 11 patients.  Radiology. 1988;  166 817-821
• 6 Bank W O, Nelson P B, Drayer B P, Wilkins R H, Rosenbaum A E. Traumatic aneurysm of the basilar artery.  AJR Am J Roentgenol. 1978;  130 975-977
• 7 Guha A, Fazl M, Cooper P W. Isolated basilar artery occlusion associated with a clivus fracture.  Can J Neurol Sci. 1989;  16 81-83
• 8 Lindenberg R. Incarceration of a vertebral artery in the cleft of a longitudinal fracture of the skull. Case report.  J Neurosurg. 1966;  24 908-910
• 9 Nezami A H, Bremer A M. Basilar artery occlusion in multiple trauma: case report.  Neurosurgery. 1980;  7 267-270
• 10 Quintana F, Diez C, Gutierrez A, Diez M L, Austin O, Vazquez A. Traumatic aneurysm of the basilar artery.  AJNR Am J Neuroradiol. 1996;  17 283-285
• 11 Woolsey R M, Chung H D. Fatal basilar artery occlusion following cervical spine injury.  Paraplegia. 1979;  17 280-283
• 12 Sights Jr W P. Incarceration of the basilar artery in a fracture of the clivus. Case report.  J Neurosurg. 1968;  28 588-591
• 13 Khan N, Zumstein B. Transverse clivus fracture: case presentation and significance of clinico-anatomic correlations.  Surg Neurol. 2000;  54 171-177
• 14 Kaakaji R, Russell E J. Basilar artery herniation into the sphenoid sinus resulting in pontine and cerebellar infarction: demonstration by three-dimensional time-of-flight MR angiography.  AJNR Am J Neuroradiol. 2004;  25 1348-1350
• 15 Taguchi Y, Matsuzawa M, Morishima H, Ono H, Oshima K, Hayakawa M. Incarceration of the basilar artery in a longitudinal fracture of the clivus: case report and literature review.  J Trauma. 2000;  48 1148-1152