Basilar Skull Fractures

RINDAH, S.KED
DOSEN PEMBIMBING : DR. P. TIGOR YEHESKIEL, SP. RAD
 Background

Basilar skull
The frequency Clivus fractures
fractures are
of basilar skull are a rare case
fracture involve
fractures in approximately
at least one of 7% to 16% of
children is 2% of all cranial
the bones that head injuries
lower than fractures with
compose the
adult in the high mortality
base of the
population (24%–80%).
skull.
Anatomy
Base of skull:
1. Anterior Cranial Fossa
2. Middle Cranial Fossa
3. Posterior Cranial Fossa
Basilar Skull Fractures
Basilar skull fractures, usually caused by substantial blunt force
trauma, involve at least one of the bones that compose the base of
the skull.
Etiology
motor vehicle
collisions Falls
caused by
high-velocity
blunt trauma
gunshot
wounds
 Pathophysiology
The location of the fracture is predictive of associated injuries:

Temporal fractures Anterior skull base Central skull base Posterior skull
(most common) fractures fractures based fractures
- carotid injury - cervical spine
- orbital injury
- injury to cranial injury
- injury to cranial nerves III, IV, V
- vertebral artery
nerves VII or VIII - Rhinnorhea or VI
injury
- mastoid - injury to the
cerebrospinal - injury to cranial lower cranial
nerve I. - carotid injury. nerves
fluid leak.
 Diagnose
Hemotympanum
• Depending on the degree of the associated brain and
cranial nerve injury.
• Low Glasgow coma scale scores.
• Clinical findings:
• hemotympanum, periorbital ecchymosis, Battle sign (postauricular Raccoon’s eyes
ecchymosis), and otorrhea or rhinnorhea.
• Patients may present with altered nausea, and vomiting.

Battle sign
Diagnose
• The initial evaluation is usually via non-contrast computed
tomography (CT) scan.
Differential Diagnosis
• Skull base fractures can often be difficult to detect on CT, particularly if linear
and noncomminuted, and a thorough knowledge of skull base anatomy is
necessary to avoid diagnosing “pseudofractures.”
• Many small neural and vascular channels and foramina that can mimic
fracture lines, as can sutures and skull base fissures.

Anterior cranial fossa pseudofractures located along

the superolateral orbital rim.
Thorough knowledge of skull base anatomy is necessary to avoid diagnosing “pseudofractures”.
Many small neural and vascular channels and foramina that can mimic fracture lines, as can
sutures and skull base fissures.
And can be a pitfall in diagnosing basilar skull fractures.
Prognosis
• Prognosis depends on the location of the injury, which is often
determined by the mechanism of injury and type of impact.
• Longitudinal clivus fractures are generally rare with rate of mortality
is higher (67–80%) than in any other clival fractures.
•Transverse clivus fractures are more common, have a low rate of
mortality.
Discussion
A 10-year-old child with a headache and vomiting came to the radiology
department after a traffic accident performs a CT scan of the head. The result
shows a fracture in the clivus bone with a transverse type, which is one part of
the basilar skull.
Discussion
Clivus fractures are classified according to their image in CT scan as
longitudinal, transverse, and oblique.
Discussion
On physical examination found periorbital ecchymosis (Racoon's eyes). In
accordance with the theory, raccoon's eyes are one of the clinical symptoms
associated with fracture of the cranial base. Based on clinical symptoms and CT
scan, the patient was diagnosed with basilar skull fractures.
 Conclusion
Basilar skull fractures are usually caused by blunt force trauma,
involve at least one of the bones that compose the base of the
skull both in the anterior, media, or posterior cranii base fossa.

Several clinical signs highly predictive of basilar skull fracture

include hemotympanum, raccoon’s eyes, Battle sign, and
otorrhea or rhinnorhea.

Clivus fractures are a rare case approximately 2% of all cranial

fractures with high mortality (24%–80%). Transverse fractures
are more common, have a low rate of mortality.
Thank you…