Key Clinical Findings & Highlights
- Highlights the surgical technique for single-stage resection and titanium mesh skull reconstruction.
- Emphasizes preoperative vascular evaluation for hypervascular scalp lesions.
- Demonstrates complete cosmetic restoration and durable bone protection.
Abstract
Introduction & Background
Diffuse neurofibroma is an infiltrative subtype of neurofibroma characterized by proliferation of Schwann cells within the subcutaneous tissue. Unlike plexiform neurofibromas, they are not strictly pathognomonic for NF-1. When located on the scalp, the hypervascularity and infiltration into the galea aponeurotica and periosteum can lead to secondary osteolysis of the calvarium.
Clinical Case Presentation & Diagnosis
A 22-year-old female presented with a rapidly enlarging, painless, rubbery swelling in the left parietal scalp region over 8 months. High-resolution computed tomography (CT) and contrast-enhanced MRI revealed a hypervascular subcutaneous scalp mass with significant full-thickness erosion of the underlying parietal skull bone, exposing the underlying dura mater without intracranial intradural invasion.
Surgical Technique & Management
Under general anesthesia, a bicoronal scalp flap was designed with meticulous hemostasis of hypertrophied scalp feeder arteries. The tumor was resected en-bloc with a clean margin. The eroded calvarial bone defect (4 cm x 3.5 cm) was reconstructed using anatomical titanium mesh fixed with self-drilling micro-screws, restoring normal cranial contour.
Discussion & Literature Context
Surgical management of diffuse scalp neurofibromas requires careful planning because of extensive vascularity and risk of significant blood loss. Complete resection of the infiltrative subcutaneous component along with reconstruction of the calvarial defect in a single stage yields superb cosmetic and protective outcomes.
Conclusion
Complete excision combined with immediate rigid cranioplasty provides definitive cure and prevents recurrence or aesthetic deformity.
How to Cite This Research
L. S. Nehete, R. Sharma, P. R. Singh, Dr. Surendra K. Gupta (2020). "Rapidly growing diffuse neurofibroma of the scalp with calvarial defect in a young woman: A rare entity". Surgical Neurology International, Volume 11, Article 313.
