Dr. Ali Al-Bayyati and Dr. Munir Elias

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The patient came to the clinic 01-October-2012 complaining of convulsions for 1 year starting with tonico-clonic movement of the right upper limb with secondary generalization. The patient was covered with Tegretol 200 mg twice daily, Topamax 25 mg twice daily and Lamictal 25 mg at the evening, after what the epiactivity decreased in intensity, but taking place 4-5 times per day , but the last month she was seizure free. The relatives noted attacks of fever during the last year of unknown origin.


EEG done 16-September-2012 confirmed partial epileptic discharges in the left temporo-occipital area. MRI of the brain done 15-September-2012 showing a cystic mass with solid component in the left occipito-temporal area resembling pilocytic astrocytoma.


On examination, the patient has weak right upper limb ranging from 4/5 to -4/5. There is also weak proximal muscles of the right lower limb 4/5.


Vertical incision between the left ear and the occipital protuberance. Osteoplastic craniotomy done to expose the posterior parts of the temporal lobe and lateral parts of the left occipital lobe. The dura was incised in T-shape to expose the lower parts abutting the left transverse sinus. The vein of Labbe is running in the middle of the field. Sharp cortical incision done behind the vein of Labbe. The tumor was directly under the cortical incision with mild fleshy-purple color. Piece meal removal of the tumor and fresh frozen result was that of low grade astrocytoma. The tumor was resected until the normal brain structures were seen all over and the tentorium was seen at the bottom of the field. No attempt was done to reach the posterior horn of the left lateral ventricle, since the medial upper wall was looking normal healthy white matter. All attempts were done to preserve the vein of Labbe and its collectors from all direction. A considerable cavity was created and the brain is lax pulsating normal. Strict heamostasis.


Routine closure of the wound. Smooth postoperative recovery and the patient sent to the ICU for proper observation.


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The patient has astrocytoma in epileptogenic area, for what the clinical manifestations were epileptical discharges.


The hemiparesis before surgery is difficult to interpret, because the mass is away from the sensory-motor strip. It could be explained by difficult venous flow by the vein of Labbe due to tumor compression. The vein of Labbe was free and lax with preserved all its branches at the end of the surgery.


The final histologic result was oligoastrocytoma Grade II.

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[2012] [CNS CLINIC - NEUROSURGERY - JORDAN]. All rights reserved