Introduction: Diastasis of clival synchondroses have been previously observed in the setting of crushing skull injuries and were uniformly associated with clival fractures. The mortality of clival fractures in pediatric patients is roughly 30%, and is often correlated with vascular injury at the skull base. Traumatic diastasis of the clival synchondroses in isolation have not been previously reported.

Methods: A focused search of the electronic medical record database at the Children's Hospital of Pittsburgh was performed to identify patients with fractures of the clivus that were diagnosed using CT of the head following trauma work up as part of initial evaluation. A retrospective review of the charts and radiographic imaging were then performed to elucidate patient demographics, mechanism of injury, skull and brain parenchymal injuries, and clinical outcomes.

Results: Sixteen patients with fractures of the clivus were identified over a five year period. The mean age of these patients was 9 years (range 1-16 years). Eleven (68.8%) of the patients had an associated traumatic diastasis of the central skull base. Five (31.3%) of the patients died. However, of the 11 patients who survived, all had a good outcome with a Glasgow Outcome Scale score of 4 or 5 at the time of discharge. The incidence of clival fractures among patients with head injuries was 0.33%. One patient had an isolated diastasis of a clival synchondrosis with associated vascular injury in the absence of bony fracture.

Conclusions: Our data regarding traumatic fractures of the clivus and associated vascular injury and outcomes has been previously reported. Isolated traumatic diastasis of the clival synchondroses may also result in similar vascular injury in the absence of bony fracture. It is therefore essential to perform focused radiological evaluation of the clival synchondroses in pediatric crush injuries, as further vessel imaging may be warranted if evidence of diastasis is present.

Patient Care: Better assessment for vascular injury in patients with no bony fracture, but rather diastasis of clival synchondroses

Learning Objectives: Trauma, Vascular Injury may occur in absence of skull base fractures due to diastasis of synchondroses

References: Ochalski PG, Adamo MA, Adelson PD, Okonkwo DO, Pollack IF. J Neurosurg Pediatr. 2011 Mar; 7(3): 261-7.