Clival fractures in children: a challenge in the trauma room setting!
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ORIGINAL ARTICLE
Clival fractures in children: a challenge in the trauma room setting! Julian Fromm 1 & Eliane Meuwly 2 & Danielle Wendling-Keim 1 & Markus Lehner 1,2
&
Birgit Kammer 3
Received: 13 June 2020 / Accepted: 4 November 2020 # Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Objective A clival fracture is a rare but life-threatening traumatic brain injury in the adult and pediatric populations. To date, there are very few conclusive recommendations in the literature concerning the diagnosis and treatment of pediatric clival fractures. Methods In 2014 and 2015, two pediatric patients with severe blunt head trauma and clival fractures were evaluated and treated at a level I trauma center. Both cases are documented and supplemented by an extensive review of the literature focusing on the diagnostic workup, classification, and clinical course of clival fractures in children. Results The clinical course of two children (8 and 9 years old) with clival fractures in concert with other intra- and extracranial injuries was analyzed. A total of 17 papers encompassing 37 patients (age range, 1–18 years) were included for a systematic review. The literature review revealed a mortality rate of 23% in pediatric patients with a clival fracture. Over 50% of the patients presented with cranial nerve damage, and two-thirds suffered from intracranial vascular damage or intracerebral bleeding. Conclusions Clival fractures are a very rare but severe consequence of blunt head trauma in the pediatric population and may be challenging to diagnose, especially in cases with an unfused sphenooccipital synchondrosis. Vascular damage following clival fractures appears to be as common in pediatric patients as in adults. Therefore, contrast-enhanced CT of the cervical spine and head and/or magnetic resonance angiography is strongly recommended to rule out vascular injury of the extra- and intracranial brain-supplying vessels within the trauma room setting. Keywords Children . Skull base fractures . Clivus . Sphenooccipital synchondrosis . Head injury . Severe traumatic brain injury . TBI
Introduction
* Markus Lehner [email protected] Julian Fromm [email protected] Birgit Kammer [email protected] 1
Department of Pediatric Surgery, Dr. von Hauner Children’s Hospital, Ludwig-Maximilians-University of Munich, Lindwurmstr. 4, 80337 Munich, Germany
2
Department of Pediatric Surgery, Children’s Hospital Lucerne, Luzerner Kantonsspital, Spitalstrasse 20, 6000 Lucerne 16, Switzerland
3
Pediatric Radiology, Department of Clinical Radiology, Ludwig-Maximilians-University Munich, Lindwurmstr. 4, 80337 Munich, Germany
A clival fracture is a rare but life-threatening traumatic brain injury that occurs in only 0.36–0.56% of all head injuries in the adult population [1, 2]. Similar to adults, the most common cause of clival fractures in children is motor vehicle accidents, followed by falls from heights [3]. Because of the rarity of this injury, only a few studies with multiple cases [
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