The patient came to the clinic 01-July-2013 complaining of headache for 1 month with double vision for three weeks with LOC for 4 days 2 weeks ago with vomiting since that.

MRI brain done 23-June-2013 showed a huge mass in the right occipito-temporal lobes involving the inferior horn of the right lateral ventricle pushing the mid structures to the left side. The mass has ring enhancement with proper borders.

On examination: the patient is alert with stable Romberg position, but the left upper limb sway down. The oculomotor nerves functioning, but the is disturbance of convergence with inward strabismus when looking to near objects. There is weak muscles left upper limb distal more than proximal with preservation of sensation.

MRI of the brain was repeated 01-July-2013 to confirm the previous data.

Right temporo-occipital approach. Through the inferior temporal gyrus above the trifurcation of the right Labbe sinus, transcortical incision above the tumor. The tumor was highly vascular with good margins. It was coagulated and resected. Fresh frozen biopsy gave the answer of highly malignant glioma. The tumor borders were followed and resected. The tumor was involving the choroid plexus of the inferior horn and the trigone. The normal choroid plexus was separated and bisected of the tumor. The CSF is coming free from the inferior horn. After major resection of the tumor bulk, the borders of the tumor was followed all over and practical radical removal of the tumor was achieved. The brain regained relaxed pulsating character. Inspection of the Labbe vein and the subtemporal area showed good relaxation of the anatomical structures. 2 pieces of surgicele were applied to the tumor bed to secure more heamostasis.

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

The histopathologist reported during surgery that the patient has malignant glioma. Practical gross radical resection is the best solution at this stage.

The final histologic result was glioblastoma multiforme with immunostaining study showing positive results for GFAP and the proliferation index (ki67) high (18%).

The patient was readmitted 2 days after discharge and MRI performed 12-July-2013 showing considerable recurrence of the tumor with hemorrhagic event inside the tumor bed. The patient was treated conservatively and discharged 16-July-2013 with high dose Decadron  4 tab three times a day to undergo radiation therapy as soon as possible.