Traumatic basilar artery incarceration following longitudinal clival fracture: illustrative case

BACKGROUND Clival fractures are rare injuries that occur following high-energy blunt trauma. Longitudinal clival fractures can lead to incarceration of the basilar artery within the bone fragments, often leading to stenosis or occlusion of the basilar artery, subsequently causing vascular compromise, significant ischemic events, and neurological deficits. The authors present a case of basilar artery incarceration following craniofacial trauma and review the relevant literature. OBSERVATIONS The reported case is of a 37-year-old male who presented following a 20-foot fall. CT angiography revealed a longitudinal fracture of the posterior wall of the right sphenoid sinus with basilar artery incarceration. CT of the head revealed pontine infarct with extension to the midbrain, indicating concern for severe shear injury and incarcerated basilar artery. The patient was transitioned to comfort care after discussion with his family. LESSONS A literature search yielded 23 patients with basilar artery incarceration following traumatic head injury, including the presented case. The most common traumatic etiologies included falls, motor vehicle crashes, and impact from a falling beam. A longitudinal clival fracture occurred in 22 patients. Angiography confirmed all cases, most commonly showing basilar artery occlusion. Outcomes were generally poor. This review further identifies the etiologies, clinical course, and radiographic features of basilar artery incarceration following craniofacial trauma. Although rare, clinicians should be aware of this devastating potential complication. https://thejns.org/doi/10.3171/CASE24870