Abducens Nerve Palsy Following Expansion Cranioplasty with Distraction Osteogenesis

Area of Science:

• Ophthalmology
• Pediatric Neurosurgery
• Craniofacial Surgery

Background:

• Childhood abducens nerve palsy (CNP) is a common cause of strabismus, with diverse etiologies including trauma, tumors, and idiopathic factors.
• Trans-sutural distraction osteogenesis (TSuDO) is a surgical technique used to correct craniosynostosis by gradually expanding the skull.
• Sixth nerve palsy, characterized by a deficit in eye abduction, can manifest for various reasons in pediatric patients.

Observation:

• Two pediatric patients developed unilateral abduction deficit after undergoing TSuDO for craniosynostosis.
• The abduction deficit, indicative of potential sixth nerve palsy, was observed following the distractor removal phase of the TSuDO procedure.
• No specific intervention was required as the condition was monitored postoperatively.

Findings:

• The observed abduction deficits in both patients resolved spontaneously within 2-4 months after the removal of the distractors.
• This represents the first documented instance of sixth nerve palsy occurring as a complication of TSuDO surgery.
• The transient nature of the palsy suggests a temporary mechanical or inflammatory effect related to the TSuDO device or procedure.

Implications:

• This finding highlights a potential, albeit temporary, neurological complication associated with TSuDO in pediatric craniosynostosis repair.
• Ophthalmologists and craniofacial surgeons should be aware of this possible adverse event and consider it in the differential diagnosis of abduction deficits post-TSuDO.
• Further research may be warranted to elucidate the exact mechanism and determine if preventative measures can be implemented for TSuDO procedures.