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

ABSTRACT Objectives Sphenoid fractures are associated with significant neurovascular risks, including blunt cerebrovascular injuries (BCVI). While computed tomography angiography (CTA) is commonly used to detect vascular injuries, its routine use in sphenoid fractures remains a debate. This study aimed to evaluate sphenoid fracture patterns associated with positive CTA findings to optimize imaging protocols. Methods This retrospective cohort study included 131 patients with sphenoid fractures from 2011 to 2023 at a tertiary care center. Of these, 88 patients underwent CTA. Fracture patterns were categorized based on anatomical involvement, and vascular injuries were graded using the Biffl scale. Statistical analyses were performed to evaluate associations between fracture types and CTA findings. Results Among the 88 patients who underwent CTA, 10 (11.4%) had vascular injuries. Fractures involving the carotid canal were significantly associated with positive CTA findings, while fractures confined to the greater wing or temporal bone were more often associated with negative findings. No significant associations were observed between vascular injuries and demographic or clinical variables. Conclusions Fractures involving the carotid canal should prompt evaluation with CTA, whereas low‐risk fractures involving the temporal bone or greater wings of sphenoid may not require routine imaging. These findings emphasize the importance of fracture location in guiding a more selective approach to CTA use. Level of Evidence 3