title: Basilar Artery Herniation into the Sphenoid Sinus Secondary to Traumatic Skull Base Fractures: Case Report and Review of the Literature.
abstract: BACKGROUND
  Traumatic clival fractures occur with less than 0.6% frequency and can be associated with significant neurovascular injuries. The most serious of these injuries is to the basilar artery in which the artery is dissected or is fully occluded, resulting in infarction of the brainstem and cerebellum. Among early reports of these injuries, postmortem autopsy showed entrapment, or incarceration, of the basilar artery at the clival fracture site. A literature search revealed 11 cases of entrapment of the basilar artery within a clival fracture.
  
  
  METHODS
  This report describes a 59-year-old man after a motor vehicle crash with computed tomography showing a basilar artery herniation through a sphenoid sinus fracture. The patient subsequently developed brainstem and cerebellar infarcts.
  
  
  CONCLUSIONS
  Basilar artery incarceration and herniation through the sphenoid sinus is rare. Such an injury portends a poor prognosis. We discuss the relevant clinical imaging and review the literature.
authors.affiliation: Department of Neurological Surgery, New York Medical College, Westchester, New York, USA. Electronic address: wanga@wcmc.com.
authors.forename: Arthur
authors.initials: A
authors.lastname: Wang
authors.affiliation: Department of Neurological Surgery, New York Medical College, Westchester, New York, USA.
authors.forename: John
authors.initials: J
authors.lastname: Wainwright
authors.affiliation: Department of Neurological Surgery, New York Medical College, Westchester, New York, USA.
authors.forename: Jared
authors.initials: J
authors.lastname: Cooper
authors.affiliation: Department of Radiology, New York Medical College, Westchester, New York, USA.
authors.forename: Michael S
authors.initials: MS
authors.lastname: Tenner
authors.affiliation: Department of Neurological Surgery, New York Medical College, Westchester, New York, USA.
authors.forename: Adesh
authors.initials: A
authors.lastname: Tandon
mesh_terms: D000063:Accidents, Traffic; D001344:Autopsy; D001488:Basilar Artery / Q000000981:diagnostic imaging / Q000293:injuries*; D000072226:Computed Tomography Angiography; D003388:Cranial Fossa, Posterior / Q000293:injuries*; D038524:Diffusion Magnetic Resonance Imaging; D015600:Glasgow Coma Scale; D006801:Humans; D021621:Imaging, Three-Dimensional; D008297:Male; D008875:Middle Aged; D020205:Skull Fracture, Basilar / Q000000981:diagnostic imaging / Q000601:surgery*; D013101:Sphenoid Sinus / Q000000981:diagnostic imaging / Q000601:surgery*
keywords: Basilar artery; Herniation; Sphenoid sinus