Reversible abducens nerve palsy following cranial vault expansion in the setting of multisutural craniosynostosis: illustrative case.

Background: Posterior cranial vault distraction osteogenesis (PVDO) is a commonly used cranial expansion procedure in infants and children with syndromic craniosynostosis. To date, there have been no reports of cranial nerve (CN) palsies in patients undergoing univector PVDO.

Observations: In this article, the authors describe the case of a 27-month-old female with Muenke syndrome who underwent long-distance (> 30 mm) PVDO and developed bilateral abducens nerve (CN VI) palsy after 40 mm of distraction. Following partial reversal of the distraction during the activation phase, the authors observed complete resolution of this palsy.

Lessons: This report demonstrates that CN palsies are a potential complication for which the patient should be monitored, even when undergoing univector PVDO. Most notably, this report illustrates that a gradual reduction in the distraction distance can result in complete resolution of a CN VI palsy while also maintaining a significant degree of intracranial expansion. https://thejns.org/doi/10.3171/CASE24762.