Primary cutis gyrata: review of literature and a successful
new surgical approach
Received: 17 June 2009 / Accepted: 14 December 2009 / Published online: 29 January 2010
Cutis verticis gyrata (CVG) is an uncommon, long-lasting
progressive condition of the scalp characterised by folds
and ridges resembling the surface of the brain with an
estimated prevalence of 1 in 100,000 in males and 0.026 in
100,000 in females . It is divided into primary CVG
which usually develops after puberty (90%) and before age
30 years and secondary CVG which is due to an underlying
pathology and may be present at birth .
Primary CVG occurs in patients with normal skin
histopathology and can be associated with neuropsychiatric
conditions such as mental retardation, schizophrenia or epi-
lepsy. Secondary CVG occurs in patients with a pathologic
change in the scalp structure as a result of a local inflam-
matory, neoplastic process of the scalp or a systemic illness
causing this pathologic change (Table 1).
Choices of treatment in CVG depend on the size of the
lesion, the underlying cause and the patient’s requests. Non-
surgical treatment is confined to removal of the cause in
secondary CVG. Surgical treatment options include primary
repair, serial excision and skin grafting, local flap and serial
tissue expansion. After review of the English literature, we
were unable to find any report of one-stage tissue
expansion followed by reconstruction for correction of
CVG. In this case series, we describe a new surgical
technique for treatment of primary CVG with single-stage
tissue expansion followed by reconstruction of the scalp.
The procedure is performed under general anaesthesia.
Depending on the extent of scalp involved, one or two
tissue expanders are placed in the subgaleal plane. The
expanders were placed either under normal skin (adjacent
to the involved scalp) or directly under the involved scalp
skinfolds. Subgaleal pre-infiltration with 0.9% normal saline
1:50,000 adrenaline was used to partially hydro-dissect the
plane prior to skin incision. Dissection is usually difficult, due
to fibrous bands running between the galea and pericranium;
however, the plane is made with a combination of sharp and
blunt dissection (with Hegar’s dilators).
Normal saline is then injected into the tissue expander
over the following weeks until there is clinical flattening of
the majority of scalp folds; residual scalp folds can then be
excised as part of the secondary procedure.
The second-stage operation involves removal of the tissue
expander(s), excision of the pathological scalp and using the
expanded scalp as an advancement flap to cover the defect.
A 25-year-old male presented with folds and furrows of the
scalp which had started as a child. Primary CVG was
diagnosed by exclusion. There was no delayed develop-
ment of milestones. There was no associative condition to
Financial support for this report was nil.
Presentations/submissions for this report were nil.
Plastic and Burns Department, University Hospital Birmingham
NHS Foundation Trust-Selly Oak Hospital,
Raddlebarn Road, Selly Oak,
B29 6JD Birmingham, UK
M. El-Husseiny (*)
21 Bramble Close,
Stanmore HA7 1QX, UK
Eur J Plast Surg (2010) 33:153–157