Clival Fracture With Multiple Cranial Nerve Palsy Treated With a Halo Device: A Case Report and Literature Review

We present a rare case of clival fracture in which the patient presented with multiple lower cranial nerve palsy (similar to Vernet syndrome or Collet-Sicard syndrome). Multiple lower cranial nerve palsy from skull base lesions includes Vernet syndrome and Collet-Sicard syndrome. Clival fracture is a rare condition, and the optimal treatment method has yet to be established. A 73-year-old man fell down a flight of stairs and was diagnosed with injuries such as traumatic intracranial hemorrhage, clival fracture, and facial bone fracture. The patient presented with bilateral cranial nerve VI, IX, X, XI, and right XII palsies caused by clival fracture but no instability at the craniocervical junction, so we performed external fixation using a halo device. The patient developed delirium in the subacute phase, which was considered to be aggravated by the halo device. We therefore safely removed the halo device on hospital day 54 after confirming porosis of the fractured clivus on computed tomography. The patient did not complain of neck pain, and paralyses of cranial nerves VI and XII had completely resolved, while those of cranial nerves IX, X, and XI had also improved, so the patient could start direct swallowing training. Clival fracture with bilateral multiple cranial nerve palsies similar to Vernet syndrome or Collet-Sicard syndrome is highly rare. Accordingly, no standard treatment has been established. A halo device can be an effective treatment for clival fracture, and the duration of fixation could be determined flexibly based on the condition of each case.