Incidence and pattern of direct blunt neurovascular injury associated with trauma to the skull base

Iman Feiz-Erfan, Eric M. Horn, Nicholas Theodore, Joseph M. Zabramski, Jeffrey D. Klopfenstein, Gregory P. Lekovic, Felipe C. Albuquerque, Shahram Partovi, Pamela W. Goslar, Scott R. Petersen

Research output: Contribution to journalArticle

Abstract

Object. Skull base fractures are often associated with potentially devastating injuries to major neural arteries in the head and neck, but the incidence and pattern of this association are unknown. Methods. Between April and September 2002, 1738 Level 1 trauma patients were admitted to St. Joseph's Hospital and Medical Center in Phoenix, Arizona. Among them, a skull base fracture was diagnosed in 78 patients following computed tomography (CT) scans. Seven patients had no neurovascular imaging performed and were excluded. Altogether, 71 patients who received a diagnosis of skull base fractures after CT and who also underwent a neurovascular imaging study were included (54 men and 17 women, mean age 29 years, range 1-83 years). Patients underwent CT angiography, magnetic resonance angiography, or digital subtraction angiography of the head and craniovertebral junction, or combinations thereof. Results. Nine neurovascular injuries were identified in six (8.5%) of the 71 patients. Fractures of the clivus were very likely to be associated with neurovascular injury (p < 0.001). A high risk of neurovascular injury showed a strong tendency to be associated with fractures of the sella turcica-sphenoid sinus complex (p = 0.07). Conclusions. The risk of associated blunt neurovascular injury appears to be significant in Level 1 trauma patients in whom a diagnosis of skull base fracture has been made using CT. The incidence of neurovascular trauma is particularly high in patients with clival fractures. The authors recommend neurovascular imaging for Level 1 trauma patients with a high-risk fracture pattern of the central skull base to rule out cerebrovascular injuries.

Original languageEnglish (US)
Pages (from-to)364-369
Number of pages6
JournalJournal of Neurosurgery
Volume107
Issue number2
DOIs
StatePublished - Aug 2007
Externally publishedYes

Fingerprint

Nonpenetrating Wounds
Skull Base
Skull Fractures
Incidence
Wounds and Injuries
Tomography
Head
Sella Turcica
Sphenoid Sinus
Posterior Cranial Fossa
Digital Subtraction Angiography
Magnetic Resonance Angiography
Neck
Arteries

Keywords

  • Blunt injury
  • Carotid artery
  • Fistula
  • Pseudoaneurysm
  • Skull base fracture
  • Vertebral artery

ASJC Scopus subject areas

  • Clinical Neurology
  • Neuroscience(all)

Cite this

Feiz-Erfan, I., Horn, E. M., Theodore, N., Zabramski, J. M., Klopfenstein, J. D., Lekovic, G. P., ... Petersen, S. R. (2007). Incidence and pattern of direct blunt neurovascular injury associated with trauma to the skull base. Journal of Neurosurgery, 107(2), 364-369. https://doi.org/10.3171/JNS-07/08/0364

Incidence and pattern of direct blunt neurovascular injury associated with trauma to the skull base. / Feiz-Erfan, Iman; Horn, Eric M.; Theodore, Nicholas; Zabramski, Joseph M.; Klopfenstein, Jeffrey D.; Lekovic, Gregory P.; Albuquerque, Felipe C.; Partovi, Shahram; Goslar, Pamela W.; Petersen, Scott R.

In: Journal of Neurosurgery, Vol. 107, No. 2, 08.2007, p. 364-369.

Research output: Contribution to journalArticle

Feiz-Erfan, I, Horn, EM, Theodore, N, Zabramski, JM, Klopfenstein, JD, Lekovic, GP, Albuquerque, FC, Partovi, S, Goslar, PW & Petersen, SR 2007, 'Incidence and pattern of direct blunt neurovascular injury associated with trauma to the skull base', Journal of Neurosurgery, vol. 107, no. 2, pp. 364-369. https://doi.org/10.3171/JNS-07/08/0364
Feiz-Erfan, Iman ; Horn, Eric M. ; Theodore, Nicholas ; Zabramski, Joseph M. ; Klopfenstein, Jeffrey D. ; Lekovic, Gregory P. ; Albuquerque, Felipe C. ; Partovi, Shahram ; Goslar, Pamela W. ; Petersen, Scott R. / Incidence and pattern of direct blunt neurovascular injury associated with trauma to the skull base. In: Journal of Neurosurgery. 2007 ; Vol. 107, No. 2. pp. 364-369.
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abstract = "Object. Skull base fractures are often associated with potentially devastating injuries to major neural arteries in the head and neck, but the incidence and pattern of this association are unknown. Methods. Between April and September 2002, 1738 Level 1 trauma patients were admitted to St. Joseph's Hospital and Medical Center in Phoenix, Arizona. Among them, a skull base fracture was diagnosed in 78 patients following computed tomography (CT) scans. Seven patients had no neurovascular imaging performed and were excluded. Altogether, 71 patients who received a diagnosis of skull base fractures after CT and who also underwent a neurovascular imaging study were included (54 men and 17 women, mean age 29 years, range 1-83 years). Patients underwent CT angiography, magnetic resonance angiography, or digital subtraction angiography of the head and craniovertebral junction, or combinations thereof. Results. Nine neurovascular injuries were identified in six (8.5{\%}) of the 71 patients. Fractures of the clivus were very likely to be associated with neurovascular injury (p < 0.001). A high risk of neurovascular injury showed a strong tendency to be associated with fractures of the sella turcica-sphenoid sinus complex (p = 0.07). Conclusions. The risk of associated blunt neurovascular injury appears to be significant in Level 1 trauma patients in whom a diagnosis of skull base fracture has been made using CT. The incidence of neurovascular trauma is particularly high in patients with clival fractures. The authors recommend neurovascular imaging for Level 1 trauma patients with a high-risk fracture pattern of the central skull base to rule out cerebrovascular injuries.",
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AU - Feiz-Erfan, Iman

AU - Horn, Eric M.

AU - Theodore, Nicholas

AU - Zabramski, Joseph M.

AU - Klopfenstein, Jeffrey D.

AU - Lekovic, Gregory P.

AU - Albuquerque, Felipe C.

AU - Partovi, Shahram

AU - Goslar, Pamela W.

AU - Petersen, Scott R.

PY - 2007/8

Y1 - 2007/8

N2 - Object. Skull base fractures are often associated with potentially devastating injuries to major neural arteries in the head and neck, but the incidence and pattern of this association are unknown. Methods. Between April and September 2002, 1738 Level 1 trauma patients were admitted to St. Joseph's Hospital and Medical Center in Phoenix, Arizona. Among them, a skull base fracture was diagnosed in 78 patients following computed tomography (CT) scans. Seven patients had no neurovascular imaging performed and were excluded. Altogether, 71 patients who received a diagnosis of skull base fractures after CT and who also underwent a neurovascular imaging study were included (54 men and 17 women, mean age 29 years, range 1-83 years). Patients underwent CT angiography, magnetic resonance angiography, or digital subtraction angiography of the head and craniovertebral junction, or combinations thereof. Results. Nine neurovascular injuries were identified in six (8.5%) of the 71 patients. Fractures of the clivus were very likely to be associated with neurovascular injury (p < 0.001). A high risk of neurovascular injury showed a strong tendency to be associated with fractures of the sella turcica-sphenoid sinus complex (p = 0.07). Conclusions. The risk of associated blunt neurovascular injury appears to be significant in Level 1 trauma patients in whom a diagnosis of skull base fracture has been made using CT. The incidence of neurovascular trauma is particularly high in patients with clival fractures. The authors recommend neurovascular imaging for Level 1 trauma patients with a high-risk fracture pattern of the central skull base to rule out cerebrovascular injuries.

AB - Object. Skull base fractures are often associated with potentially devastating injuries to major neural arteries in the head and neck, but the incidence and pattern of this association are unknown. Methods. Between April and September 2002, 1738 Level 1 trauma patients were admitted to St. Joseph's Hospital and Medical Center in Phoenix, Arizona. Among them, a skull base fracture was diagnosed in 78 patients following computed tomography (CT) scans. Seven patients had no neurovascular imaging performed and were excluded. Altogether, 71 patients who received a diagnosis of skull base fractures after CT and who also underwent a neurovascular imaging study were included (54 men and 17 women, mean age 29 years, range 1-83 years). Patients underwent CT angiography, magnetic resonance angiography, or digital subtraction angiography of the head and craniovertebral junction, or combinations thereof. Results. Nine neurovascular injuries were identified in six (8.5%) of the 71 patients. Fractures of the clivus were very likely to be associated with neurovascular injury (p < 0.001). A high risk of neurovascular injury showed a strong tendency to be associated with fractures of the sella turcica-sphenoid sinus complex (p = 0.07). Conclusions. The risk of associated blunt neurovascular injury appears to be significant in Level 1 trauma patients in whom a diagnosis of skull base fracture has been made using CT. The incidence of neurovascular trauma is particularly high in patients with clival fractures. The authors recommend neurovascular imaging for Level 1 trauma patients with a high-risk fracture pattern of the central skull base to rule out cerebrovascular injuries.

KW - Blunt injury

KW - Carotid artery

KW - Fistula

KW - Pseudoaneurysm

KW - Skull base fracture

KW - Vertebral artery

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