A Mysterious Case of Giant Scalp Devil's Horn with Intracranial Extension Removed by Surgical Excision

Cutaneous horn or sebaceous horns are rare form of lesion consisting of keratotic material resembling that of an animal horn. The shape is conical or cylindrical Hyperkeratosis of variable size. The lesion typically occurs in sun exposed areas. Herewith we report a case of cutaneous horn in the scalp praieto occipital region with underlying bony erosion and intracranial extension. A 60-year-old male patient presented to the neurosurgery department in February 2024 with altered consciousness, a history of chronic headaches, blurred vision, and scalp swelling. Under general anaesthesia the outer fungating part of the lesion was excised initially followed by craniotomy and internal decompression of the lesion done by suction and cauterisation, the central part of the lesion was nearly avascular and was cheezy white. Then the poorly vascularised thick membrane was excised by gentle traction and cauterisation from the sorrounding adjacent gliotic area of left parietal lobe laterally, from the falx medially and from corpus callosum inferiorly. With meticulous hemostasis wound closure done by scalp rotation flap keeping cranioplasty in situ.