P.109 Management of a maxillofacial, transclival penetrating injury

Abstract

Background: Penetrating traumatic injuries to the clivus are rare. We describe the case of a 79-year-old man who presented to the emergency room with a butter knife protruding from his left cheek. Imaging showed the blade entering just beneath the left zygoma and transecting the clivus to terminate within the prepontine cistern. The tip of the knife abutted the right anterior inferior cerebellar artery and lower basilar artery. Methods: He was brought to the interventional neuroradiology OR with knife in place, by a combined surgical team of ENT, neurosurgery, and neuroradiology. Under local anaesthetic and intravenous sedation, vascular access to the distal left vertebral artery was obtained and a balloon positioned. Traction was applied to the knife and the knife was successfully removed avoiding any angular or rotational movements. An immediate angiogram showed no evidence of arterial injury. Results: The patient recovered uneventfully and was discharged home with no neurological deficit. Follow-up CT/CTA was performed a month later and confirmed no pseudoaneurysm or other complication. Conclusions: Management of penetrating skull base injuries by a multidisciplinary surgical team is advisable. Vascular imaging is crucial. Positioning of balloons within large vessels close to the penetrating object is recommended to control bleeding that may occur on removal.