In addition to a routine head CT (5-mm axial slices), high-resolution images through the skull base are needed to evaluate skull-base injury (1- to 3-mm axial slices). 5 Underlying brain parenchymal injury or vascular injury is not evaluated on skull x-rays, and the presence or absence of a skull fracture does not adequately predict concomitant injuries.įor the diagnosis of skull-base trauma, CT is the mainstay modality. Skull x-rays play a limited role in evaluation for trauma at the skull base. Vascular complications, such as an arteriovenous fistula, are often best evaluated on conventional angiography with the potential for immediate endovascular intervention. MRI is also useful for evaluation of long-term post-traumatic sequelae such as cranial nerve injury.Ĭonventional angiography plays a limited role in the immediate assessment of skull-base trauma, but it may be helpful after initial imaging has been obtained to evaluate for traumatic vascular injury, especially if computed tomographic angiography (CTA) is limited or equivocal. MRI may also detect associated injuries, for example, spinal trauma or subtle intracranial injuries that are poorly delineated by CT, including diffuse axonal injury, brainstem trauma, and small cortical contusions. This may include a CT angiogram of the head and neck or magnetic resonance imaging (MRI) of the craniocervical junction to look for associated complications. The need for additional imaging is determined by the clinical scenario and the presence of injury. Imaging of the skull base requires high-resolution axial images with coronal and sagittal reformats. 4 Hence, the presence of spinal or maxillofacial trauma predicts a higher likelihood of a skull-base fracture.Ĭomputed tomography (CT) is the mainstay imaging modality in the initial assessment of patients with suspected skull-base trauma. 3 In patients with trauma to the upper cervical spine, 23% will also have a fracture of the skull base. 2 Of patients with facial trauma, the overall frequency of skull-base trauma is 25%. 1 Recent advances in medical imaging have allowed for increased detection of subtle injuries in a rapid, noninvasive manner.įractures of the skull are reported in 3.5 to 24% of patients with head injury. Because of the complex anatomy at the skull base, the initial injury can result in various complications, ranging from cranial nerve deficits to devastating vascular injury. Skull-base trauma is an important cause of long-term neurologic sequelae, permanent disability, and death.
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