Abstract
BACKGROUND: Cutis verticis gyrata (CVG) is a rare benign scalp condition that causes the formation of skin ridges and furrows. Because of the altered scalp anatomy, this condition can pose unique challenges in neurosurgical procedures. OBSERVATIONS: The authors report the case of a 47-year-old man with CVG and neurosarcoidosis who developed hydrocephalus requiring a ventriculoperitoneal shunt. Initial shunt placement at Kocher's point proceeded without complications. However, the patient presented several months later with shunt failure caused by migration of the proximal catheter. The cause of this was determined to be related to the patient's scalp hypermobility. After shunt revision and fixation of the hardware using titanium plates and screws, the patient had an uneventful recovery and a stable outcome at follow-up. LESSONS: This case emphasizes the importance of preoperative planning and intraoperative measures tailored to CVG patients. Further research is needed to elucidate the condition's neurosurgical implications and optimize procedural outcomes. https://thejns.org/doi/10.3171/CASE25174.