Heterotopic Intracranial Skin Presenting as Chronic Draining Sinus After Remote Craniotomy

Husain al-Qattan, Joanna E. Gernsback, Ajani G. Nugent, Kirill A. Lyapichev, Ricardo J Komotar, Harvey Chim

Research output: Contribution to journalArticle

1 Citation (Scopus)

Abstract

Background Craniotomies for trauma are associated with a significant risk of wound complications. We report a case in which a chronic nonhealing draining sinus was caused by an ectopic epidermal lining deep to the craniotomy bone flap, adherent to the underlying dura. Case Description A 61-year-old man was examined for a 3-year-old, nonhealing scalp wound resulting after a traumatic brain injury. His initial surgery consisted of an intracranial hematoma evacuation through a temporoparietal craniotomy; this was complicated by wound dehiscence and a chronic sinus draining clear fluid that did not resolve with antimicrobial therapy. Intraoperatively, a layer of hair-bearing skin adherent to the dura was found deep to the entirety of the previous bone flap. There was no dura tear or overt cerebrospinal fluid leak. This necessitated removal of the skin over the dura as well as the overlying bone flap. The resultant defect was reconstructed with a titanium mesh and hydroxyapatite cranioplasty, with a scalp rotation flap for coverage of the cutaneous defect. Pathology confirmed skin with intact adnexal structures. Conclusion This case demonstrates that it is possible for hair-bearing skin to grow directly on dura, deep to an intact craniotomy bone flap. With a chronic draining sinus in the absence of computed tomography and magnetic resonance imaging findings, this should be part of the differential diagnosis.

Original languageEnglish (US)
Pages (from-to)882.e9-882.e14
JournalWorld Neurosurgery
Volume98
DOIs
StatePublished - Feb 1 2017

Fingerprint

Craniotomy
Skin
Bone and Bones
Wounds and Injuries
Scalp
Hair
Durapatite
Titanium
Tears
Hematoma
Differential Diagnosis
Tomography
Magnetic Resonance Imaging
Pathology

Keywords

  • Calvarial reconstruction
  • Cranioplasty
  • Craniotomy
  • CSF leak
  • Ectopic
  • Head trauma
  • Heterotopic
  • Intracranial skin
  • Rotation flap
  • Wound infection

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology

Cite this

Heterotopic Intracranial Skin Presenting as Chronic Draining Sinus After Remote Craniotomy. / al-Qattan, Husain; Gernsback, Joanna E.; Nugent, Ajani G.; Lyapichev, Kirill A.; Komotar, Ricardo J; Chim, Harvey.

In: World Neurosurgery, Vol. 98, 01.02.2017, p. 882.e9-882.e14.

Research output: Contribution to journalArticle

al-Qattan, Husain ; Gernsback, Joanna E. ; Nugent, Ajani G. ; Lyapichev, Kirill A. ; Komotar, Ricardo J ; Chim, Harvey. / Heterotopic Intracranial Skin Presenting as Chronic Draining Sinus After Remote Craniotomy. In: World Neurosurgery. 2017 ; Vol. 98. pp. 882.e9-882.e14.
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AB - Background Craniotomies for trauma are associated with a significant risk of wound complications. We report a case in which a chronic nonhealing draining sinus was caused by an ectopic epidermal lining deep to the craniotomy bone flap, adherent to the underlying dura. Case Description A 61-year-old man was examined for a 3-year-old, nonhealing scalp wound resulting after a traumatic brain injury. His initial surgery consisted of an intracranial hematoma evacuation through a temporoparietal craniotomy; this was complicated by wound dehiscence and a chronic sinus draining clear fluid that did not resolve with antimicrobial therapy. Intraoperatively, a layer of hair-bearing skin adherent to the dura was found deep to the entirety of the previous bone flap. There was no dura tear or overt cerebrospinal fluid leak. This necessitated removal of the skin over the dura as well as the overlying bone flap. The resultant defect was reconstructed with a titanium mesh and hydroxyapatite cranioplasty, with a scalp rotation flap for coverage of the cutaneous defect. Pathology confirmed skin with intact adnexal structures. Conclusion This case demonstrates that it is possible for hair-bearing skin to grow directly on dura, deep to an intact craniotomy bone flap. With a chronic draining sinus in the absence of computed tomography and magnetic resonance imaging findings, this should be part of the differential diagnosis.

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