The patient came to the clinic 25-May-2015 fro Saudi Arabia complaining of convulsions for 2 years with history of fever and headache with right sided hemiparesis and hypalgesia for 2 months. MRI of the brain done 19-March-2015 showing huge cystic mass left fronto-temporal area with massive edema. The patient was treated for abscess and repeat MRI done 16-April-2015 showed dramatic shrinkage of the abscess. The patient was discharged and came with fever to the clinic. 

On examination; the patient is complaining of headache with nausea, blurred vision both eyes. The patient is left handed and has right sided hemiparesis 3/5 and hypalgesia.

The patient was admitted and repeat MRI of the brain showed the abscess in the same region with spectroscopy excluding the tumorous nature of the lesion. The Choline is very low and the lipids 1.3 and 0.9 are high. The patient was covered with Vancomycin, Rocephine and Flagyl.

Cardiac consultation showed that the patient has congenital defects , that G.A and hypotension will be of great risk and high mortality.

Using RM (Riechert-Mundinger System), Inomed Planning software and intraoperative MRI with local anaesthesia, the abscess was reached fro burr hole and using ventricular end of PS Medical of shunt, the abscess was evacuated. It was yellow brown thick in consistency and sent for CXS and histologic studies. The wall of the abscess was inspected it was a swollen brain with no proper separable capsule. The cavity was irrigated with saline and the ventricular tube left in the cavity and connected to Ready-Vac drain. The wound was closed and MRI after that showed shrinkage of the cavity and the tube hanging in the upper corner of the cavity. 

The patient was sent for ICU for 12 hours for observation.

The patient was operated without any sedation with local anaesthesia using Xylocain and Marcaine. The patient during surgery was in complete communication that no neurologic deficit was noted, considering that the abscess was in the left senso-motor area.