Rallo Michael S, Nosko Michael, Agag Richard L, Xiong Zhenggang, Al-Mufti Fawaz, Roychowdhury Sudipta, Nanda Anil, Gupta Gaurav
Department of Neurosurgery, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA.
Department of Plastic Surgery, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA.
World Neurosurg. 2019 May;125:392-397. doi: 10.1016/j.wneu.2019.01.217. Epub 2019 Feb 11.
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 nonessential, 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. A review of the available literature, including description of the epidemiology, pathophysiology, histology, and typical management of CVG, is provided. However, we identified no literature describing the complications of CVG in the setting of a craniotomy.
The patient presented here is a 54-year-old man with CVG who presented with occlusion of the M2/M2 branches of the middle cerebral artery, resulting in malignant cerebral edema, requiring emergent management via decompressive craniectomy. Because of the thickening of the scalp, skin incision was complicated by bleeding and difficulty in achieving hemostasis using Raney clips. Plastic surgery was consulted intraoperatively for assistance with complex closure of the wound in a multilayered fashion. Despite this, the patient's postoperative course was complicated by cerebrospinal fluid leakage due to difficulty in approximating the incision during closure. Subsequent cranioplasty was performed jointly between neurosurgery and plastic surgery.
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 postoperative course if adequate approximation of the tissues cannot be achieved, resulting in wound infection and/or cerebrospinal fluid leak. The presented patient benefited from a combined neurosurgical and plastic surgical approach that was implemented intraoperatively and continued through the postoperative stages and the subsequent cranioplasty.
头皮回状颅皮（CVG）是一种罕见的头皮疾病，其中真皮增厚导致出现类似大脑皮层的坚硬褶皱和沟纹。原发性CVG有两种形式：原发性，即CVG是唯一的表现问题；继发性，即头皮状况与神经精神疾病同时出现。CVG也可继发于多种原因，包括炎症、肿瘤、代谢性疾病或药物使用。本文提供了对现有文献的综述，包括CVG的流行病学、病理生理学、组织学和典型治疗方法的描述。然而，我们未发现有文献描述在开颅手术情况下CVG的并发症。
本文介绍的患者是一名54岁患有CVG的男性，因大脑中动脉M2/M2分支闭塞导致恶性脑水肿，需要通过减压性颅骨切除术进行紧急治疗。由于头皮增厚，皮肤切口出现出血并发症，使用雷尼夹止血困难。术中咨询整形外科以协助进行复杂的多层伤口闭合。尽管如此，患者术后过程仍因闭合时切口难以对合而出现脑脊液漏并发症。随后神经外科和整形外科联合进行了颅骨成形术。
尽管CVG罕见，但神经外科医生了解它很重要，因为它在开颅手术中可能出现并发症，最明显的是在头皮暴露和闭合过程中。如果组织不能充分对合，CVG也可能使术后过程复杂化，导致伤口感染和/或脑脊液漏。本文介绍的患者受益于术中实施并持续到术后阶段及后续颅骨成形术的神经外科和整形外科联合方法。
