Ham Chang Hwa, Kwon Woo-Keun, Kim Joo Han, Park Youn-Kwan, Kim Jong Hyun
Focused Training Center for Trauma, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea.
Department of Neurosurgery, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea.
J Trauma Inj. 2023 Jun;36(2):147-151. doi: 10.20408/jti.2022.0058. Epub 2022 Dec 8.
Avulsion fracture of the occipital condyle are rare lesion at craniovertebral junction. It is often related to high-energy traumatic injuries and show diverse clinical presentations. Neurologic deficit and instabilities may justify surgical treatment. However, the integrity of neurovascular structures is undervalued in the current literatures. In this case report, we described a 26-year-old female patient with avulsion fracture of occipital condyle following a traffic accident. On initial presentation, her Glasgow Coma Scale was 8. She presented with fracture compound comminuted depressed, on the left side of her forehead with skull base fracture extending into clivus and occipital condyle. Her left occipital condyle showed avulsion injury with displacement deep into the skull base. On her computed tomography angiography, the displaced occipital condyle compressed on the sigmoid sinus resulting in its obstruction. While she was recovering her consciousness during her stay in the hospital, the lower cranial nerves showed dysfunctions corresponding to Collet-Sicard syndrome. Due to high risk of vascular injury, the patient was conservatively treated for the occipital condyle fracture. On the 4 months postdischarge follow-up, her cranial nerve symptoms practically recovered, and the occipital condyle showed signs of fusion without further displacement. Current literatures focus on neurologic deficit and stability for the surgical decisions. However, it is also important to evaluate the neurovascular integrity to assess the risk of its manipulation as it may result in fatal outcome. This case shows, an unstable avulsion occipital condyle fracture with neurologic deficit can be treated conservatively and show a favorable outcome.
枕髁撕脱性骨折是一种发生于颅颈交界区的罕见损伤。它常与高能量创伤性损伤相关，临床表现多样。神经功能缺损和不稳定可能需要手术治疗。然而，神经血管结构的完整性在当前文献中未得到足够重视。在本病例报告中，我们描述了一名26岁女性患者，她在交通事故后发生了枕髁撕脱性骨折。初次就诊时，她的格拉斯哥昏迷量表评分为8分。她表现为左侧额部骨折伴粉碎性凹陷骨折，颅底骨折延伸至斜坡和枕髁。她的左侧枕髁显示撕脱伤，移位至颅底深部。在她的计算机断层扫描血管造影中，移位的枕髁压迫乙状窦导致其阻塞。在她住院期间意识恢复过程中，较低的颅神经出现了与科莱-西卡尔综合征相符的功能障碍。由于血管损伤风险高，该患者的枕髁骨折采用保守治疗。出院后4个月随访时，她的颅神经症状基本恢复，枕髁显示融合迹象且无进一步移位。当前文献在手术决策方面侧重于神经功能缺损和稳定性。然而，评估神经血管完整性以评估其操作风险也很重要，因为这可能导致致命后果。本病例表明，伴有神经功能缺损的不稳定枕髁撕脱性骨折可以采用保守治疗并取得良好效果。
