Analysis of Carotid Artery Injury in Patients With Basilar Skull Fractures Gordon H. Sun, Nael M. Shoman, Ravi N. Samy, and Myles L. Pensak Department of OtolaryngologyYHead and Neck Surgery, University of Cincinnati/Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, U.S.A. Objectives: Determine the prevalence of carotid artery injury (CAI) in patients with basilar skull fractures and describe sig- nificant demographic and radiographic risk factors for CAI. Study Design: From January 2004 to December 2008, medical records of 1,279 consecutive adult patients treated for basilar skull fractures at a tertiary care academic hospital were retro- spectively reviewed. Diagnostic angiography was performed in 112 patients because of concern for CAI. Computed tomo- graphic studies of the head and cranial base were reviewed for evidence of pneumocephalus, petrous carotid canal fractures, and sphenoid bone fractures. Results: Mean age of patients undergoing angiography was 38.7 years, and 85 patients (75.9%) were male subjects. Thirty- five (50%) of 70 discrete cerebrovascular injuries on angi- ography involved the carotid canal. The prevalence of CAI in patients with basilar skull trauma was 2.0%. CAI was associated with female sex ( p = 0.001), whereas lower Glasgow Coma Scale score approached statistical significance ( p = 0.07). Sensitivity and specificity of the 3 computed tomographic findings individually were 44% to 68% and 41% to 67%, re- spectively. With all 3 findings concurrently, 85% specificity and 80% negative predictive value for CAI were obtained, although sensitivity declined. Conclusion: The frequency of CAI in patients with basilar skull fractures was higher than that in those without basilar skull involvement. Female sex was strongly associated with CAI. The intimate anatomic relationship between the carotid artery and the cranial base posit substantial diagnostic and therapeu- tic challenges for the contemporary cranial base surgeon, and thus, understanding the epidemiology and risk factors for CAI is of paramount importance. Key Words: Carotid arteryV ComplicationsVFractureVInjuryVTemporal bone. Otol Neurotol 32:882Y886, 2011. Head trauma is a common medical emergency world- wide. An epidemiologic study of the National Trauma Data Bank performed by Mulligan et al. (1) reported 334,864 cases of head injury in the United States and Puerto Rico from 2002 to 2006. An estimated 4% to 30% of head injuries include basilar skull fractures (2,3). Numerous critical complications have been attributed to fractures of the lateral and central cranial base, including intracranial trauma, cerebrospinal fluid leakage, cranial nerve palsies, vertebral artery injury, and carotid artery injuries (CAIs), such as carotid-cavernous fistula (4Y9). CAI, which has a 0.05% to 1.1% incidence in selected cohorts of trauma patients, is associated with substantial morbidity and death (6,10Y14). Previous studies have reported neurologic deficits of 48% to 58% and mortality rates ranging from 17% to 31% in patients sustaining CAI (11,12,15). The ability to predict the occurrence of CAI in patients with head and cranial base trauma using computed tomography (CT) imaging alone, before the onset of neu- rologic deficits or before more invasive, time-consuming, and costly diagnostic tools, such as angiography, are used, would be invaluable in the management of cranial base trauma patients. The gold standard diagnostic tool for identifying CAI in head trauma patients is 4-vessel cerebral angiography (VCA) (16). However, computer tomographyYangiography (CTA) and magnetic resonance angiography (MRA) are viable alternatives that also provide additional details on concomitant intracranial and extracranial injuries. Using these diagnostic modalities, several studies have investi- gated the frequency of carotid canal fractures and other central cranial base trauma in head trauma patients sus- taining CAI (9,17,18). The current study attempted to Address correspondence and reprint requests to Ravi N. Samy, M.D., F.A.C.S., Department of Otolaryngology, UC/CCHMC, 231 Albert Sabin Way, Cincinnati, OH 45267-0528; E-mail: Ravi.Samy@UC.edu Conflict of Interest Statement: Dr. Samy has the following dis- closures: Otokinetics (Advisory Board), Pilus Energy (Advisory Board and Investor), and Surgical Metrics, LLC (Member). No other authors have any pertinent disclosures. There were no sources of funding for this article. Otology & Neurotology 32:882Y886 Ó 2011, Otology & Neurotology, Inc. 882 Copyright © 2011 Otology & Neurotology, Inc. Unauthorized reproduction of this article is prohibited.