Bilateral 6th nerve palsy due to intracranial hypertension after methyl methacrylate cranioplasty: a case report

Abstract

BACKGROUND: Intracranial hypertension after cranioplasty is unusual. We report a case of bilateral 6th nerve palsy secondary to intracranial hypertension that occurred in the immediate aftermath of methyl methacrylate cranioplasty following surgical resection of Ewing’s sarcoma of the occipital bone. CASE PRESENTATION: A 21-year-old woman presented with a gradually enlarging occipital mass, non-painful but cosmetically concerning. Angio scanning revealed a large, vascularized, extracranial mass with malignant features and occipital bone erosion. Surgical excision, including bone resection, identified Ewing’s sarcoma. Postoperatively, she developed headaches, blurred vision, and diplopia. Ophthalmological examination revealed swollen optic discs and restricted ocular motility. Imaging ruled out intracranial involvement but showed inflammatory changes at the cranioplasty site. Lumbar puncture confirmed intracranial hypertension secondary to cranioplasty. Treatment with acetazolamide and potassium led to a positive functional outcome.CONCLUSIONS: This case underscores the need for heightened awareness regarding potential complications associated with cranioplasty, particularly when utilizing materials like methyl methacrylate.