Heterotopic brain tissue in the scalp

A posterior midline cutaneous lesion in the scalp of a 15-month-old child was excised. Clinical examination, extensive investigations and finally surgery revealed no intracranial connection. Histologically, the lesion was composed of well differentiated meningeal, glial and cerebral tissues, establishing it to be heterotopic brain tissue. Even when all preoperative procedures exclude the diagnosis of cephaloceles, surgeons should keep in mind the possibility of an intracranial connection of any midline scalp lesion in a child and the subsequent risk of meningitis.