It was better to operate the patient in early stages to avoid all these complication.

It was not wise to perform such major surgery and send it to another hospital where the proper care is lacking.

A lot of information was lost due to the absence of the patient after surgery.

The patient an Iraqi citizen was transferred from Al-Bashir hospital 30-May-2002 with manifestations of headache, loss of hearing right ear for 1 years with tinnitus, right facial paresis for 4 months, ataxic gait and swallowing difficulty. MRI done recently showing giant right acoustic schwannoma  compressing the brain stem and extending down to the foramen magnum right side.

On examination: The patient has beside the mentioned above manifestations let sided paresis with diplopea due to right sided abducens paresis and bobbing nystagmus when looking to all directions.

Setting position. Wide right occipital osteoplastic craniotomy with incision of the dura parallel to the right transverse and sigmoid sinus. The posterior border of the tumor was seen and followed. Piece-meal resection of the tumor was proceeded and drilling to obtain transmeatal approach was achieved to remove the intracanalicular part of the tumor. All effort were paid to preserve the right facial nerve, which was shifted anterior. The inferior parts of the tumor were separated of the running caudal nerves and removed. Strict hemostasis and closure. The patient was sent to the ICU.  CT-scan was performed showing radical resection of the tumor. The patient was supposed to return to Al-Bashir hospital , for what tracheostomy was performed 3 days after surgery. The patient was extubated in T-piece and sent to Al-Bashir hospital.

The patient came to the clinic 21-December-2002 with MRI done 15-December-2002 showing no remnant of the tumor and NCS telling partial function of the right facial nerve.

The patient then came 04-March-2003 with the tracheostomy still in place, but she can talk when closing it. She was advised to be admitted to Al-Bashir hospital for tracheostomy removal.

The patient then came 11-October-2003 without tracheostomy since 22-August-2003 with left hemiparesis and bobbing both eyes and right abducens paresis.

The patient then came 25-April-2005 walking with aid with blurring vision and weak left upper limb and still paretic right abducens nerve.