Essentials of neurosurgery

Martin Greenberg

The scalp is composed of five layers: the skin; subcutaneous tisue epicranial aponeurosis, or galea; loose areolar tissue; and pericranium. The skin is thick and contains hair and sebaceous glands. The subcutaneous tissue is fibrotary has a network of fibrous septae, and is richly vascular to branches of the external and internal carotid arteries anastomose in this layer. The epicranial aponeurosis, or galea, is a strong, tendinous sheet with three attachments: anteriorlyof the frontalis muscle, posteriorly to the occipitalis muscle, and laterally to the small temporoparietalis muscles. The galeal closure is the key for ensuring scalp flap integrity in thepostoperative neurosurgical patient.