Neurosurgical and Scalp Reconstructive Challenges During Craniotomy in the Setting of Cutis Verticis Gyrata.

Cutis verticis gyrata (CVG) is a rare condition of the scalp in which thickening of the dermis induces rigid folds and furrows resembling the cerebral cortex. Two forms of primary CVG exist, essential in which CVG is the only presenting problem and non-essential in which the scalp condition occurs along with neuropsychiatric ailments. CVG can also occur secondary to a variety of causes including inflammatory, neoplastic, and metabolic conditions or drug use. Despite its rarity, CVG is an important issue for neurosurgeons to understand as it can present complications in performing craniotomy, most notably during the scalp exposure and closure. CVG may also complicate the post-operative course if adequate approximation of the tissues cannot be achieved resulting in wound infection and cerebrospinal fluid leak. Here we provide a brief review of the literature to provide neurosurgeons with an introduction to the condition, along with a case presentation exemplifying the challenges of performing a neurosurgical procedure in a patient with CVG. The presented patient benefited from a combined neurosurgical and plastic surgical approach that was implemented intraoperatively and continued through the post-operative stages and the subsequent cranioplasty.