Utility of Computed Tomography Angiography in Characterizing Vascular Injury From Sphenoid Fractures

Area of Science:

• Neurosurgery
• Radiology
• Trauma Surgery

Background:

• Sphenoid fractures pose significant neurovascular risks, including blunt cerebrovascular injuries (BCVI).
• Computed tomography angiography (CTA) is crucial for detecting vascular injuries, but its routine use in sphenoid fractures is debated.
• Optimizing imaging protocols for sphenoid fractures is essential to balance diagnostic yield and resource utilization.

Purpose of the Study:

• To identify sphenoid fracture patterns associated with positive CTA findings for vascular injuries.
• To guide the selective use of CTA in patients with sphenoid fractures.
• To refine imaging protocols for evaluating neurovascular risks in sphenoid fractures.

Main Methods:

• Retrospective cohort study of 131 patients with sphenoid fractures (2011-2023).
• 88 patients underwent CTA; fracture patterns were categorized by anatomical involvement.
• Vascular injuries were graded using the Biffl scale; statistical analyses correlated fracture types with CTA findings.

Main Results:

• 10.4% of patients who underwent CTA had vascular injuries.
• Fractures involving the carotid canal were significantly associated with positive CTA findings.
• Fractures of the greater wing or temporal bone were more often associated with negative CTA findings.

Conclusions:

• CTA is recommended for sphenoid fractures involving the carotid canal due to BCVI risk.
• Routine CTA may not be necessary for low-risk fractures of the temporal bone or greater wings.
• Fracture location is key to a selective CTA approach, optimizing diagnostic strategies for sphenoid fractures.