The patient came to the clinic 27-June-2013 complaining of severe headache for 2 weeks with blurred vision. For 2 months having ataxic gait with memory disturbances. The patient suffered bullet injury to the abdomen 1993 for what he underwent several surgeries for the abdomen, the last was done 2 months ago for intraperitoneal scar. He is diabetic. Subgalial lipoma resection occipital left side performed 1996.

MRI of the brain done 24-June-2013 showing a huge mass in the right cerebellar hemisphere pushing the third ventricle and causing secondary hydrocephalus with subependymal reaction.

On examination: The patient was limping with shuffling gait. The patient walk with help of 2 persons. Horizontal nystagmus when looking to both sides, more to the right. Right sided hemiparesis more pronounced in the upper limb.

It was explained to the sons of the patient that the tumor mostly a malignant clinically and morphologically. MTS could not be ruled out, despite the fact he was investigated thoroughly by the general surgeon.

Setting position was avoided to escape air embolism in such patient with such age. Supine position with Mayfield fixing the head to bring the right occipital area upper most. Midline incision  with dissection more to the right. The bone defect was created over the right cerebellar hemisphere. Incision of the dura parallel to the transverse sinus. The tumor is involving the dura and it was abnormally bleeding. The tumor was highly vascular and it had no proper borders. Fresh frozen biopsy was that of highly malignant glioma. The tumor was followed to all directions until the tentorium was seen and the right side of vermis and right tonsil were identified. The lateral pole of the right cerebellum was also seen and the CS came fro the cisterna magna and pontocerebellar cistern. A wide cavity was created and proper heamostasis was achieved and surgicele was applied to the tumor bed. Lyodura patch was applied to gain water-tight closure.

Routine closure of the wound. Smooth postoperative recovery. The patient sent to the ICU.

The patient has a malignant tumor. This is by clinical and radiologic studies. Only final widened histologic studies can bring the proper diagnosis.