Post traumatic herniation of basilar artery into sphenoid sinus with preserved arterial flow-an unusual complication

Abstract Background Fractures of the sphenoid sinus and clivus are uncommon and vertebrobasilar herniation within a sphenoid sinus fracture is a rare occurrence, with few reported cases in literature. Such cases are often associated with secondary intracranial ischemia due to vascular injury and secondary thrombotic events which often result in significant disability. We report clinical management of a case of basilar artery herniation with entrapment of the basilar artery into the sphenoid sinus through a fracture of the posterior wall with relatively minimal neurological morbidity. Case report A previously healthy 20-year-old female was admitted via the Emergency Department (ED) to a metropolitan trauma centre following a fall from a five-storey height. On scene the patient had a Glasgow Coma Scale (GCS) score was 4 with a dilated left pupil. CT scan and CT angiography of the extra and intra cranial arteries revealed fracture of the sphenoid sinus with entrapped basilar artery but with distal preserved flow along with multifocal traumatic brain injury and rib fractures. Conclusion We discuss briefly the clinical management and progress of the patient along with review of the literature of this uncommon complication of Base of the skull fracture.