The patient is a Libyan citizen, was transferred from Cairo to Amman to Al-Hayat hospital 27-February-2012. The patient start to suffer for headache and weak left limbs for 6 months, for MRI investigations were done and showing a glioma of the right frontal lobe. The patient underwent radiation for 6 weeks over 6 week period time. Despite, that the condition of the patient continued to deteriorate.

On examination, the patient cannot walk with hemiparesis left side, more pronounced in the upper limb. The patient is talking and understand the verbal command. The patient is left handed, but using the right hand for writing. The patient before surgery was stuporous, with complete plegia of the left leg and severe weak left upper limb with status epilepticus.

The last MRI of the brain performed 13-February-2012 showing glioblastoma multiforme of the right frontal lobe with massive edema involving the entire right hemisphere with extension to the corpus callosum and reaching the splenium.

Wide right frontal craniotomy was created and the tense dura was opened in the most anterior part of the bone defect, 4 cm parallel tot eh edge. This was done to gain sufficient visual control and at the same time the small dural incision, will be welcomed after using Gliadel, in case of possible postoperative wound dehiscence or necrosis.  Partial frontal lobectomy with removal of the rubbery rounded mass near the falx cerebri, around 7x7 cm. It was removed by piece-meal fashion and the feeders were coagulated to keep the control over bleeding. The tumor bed was inspected and control heamostasis was achieved. 18 Gliadel wafers were sealed to the wall of the created cavity after tumor resection. The wafers were more secured with surgicele to prevent their migration. No attempt was done to expose the ventricular system to prevent intraventricular dissemination of the wafers.

Routine closure of the wound. Smooth postoperative recovery with improvement of the power of the legs and hands and the patient became more alert. Immediate brain CT-scan was done proving the resection of the visible mass and the position of the surgicele and absence of hematoma.

The patient underwent radiation therapy, which proved ineffective. The only option remain to employ chemotherapy. Since the best option as general is to resect as much of the tumor and implant Gliadel wafers inside the tumor bed cavity.

It was explained to the relatives, that Gliadel is an expensive drug and never cure the patient, but can give a hope for protracted survival time.

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