The patient then came to the clinic 03-July-2004 complaining of unsteady gait with ataxia and headache with left sided paresis for several months with horizontal nystagmus when looking to the left. The patient was operated elsewhere 2 years ago for alleged arachnoid cyst, but the problem persisted and a dural pocket from the bone defect was bulging under the skin at the bone defect area.

The patient was sent for new MRI of the brain which was done 10-October-2004 showing the cystic mass of huge volume extending down to the C2 lamina level.

On examination: the patient is limping dragging the left side of the body. Romberg unstable with horizontal nystagmus when looking to the left.

Osteoplastic craniotomy for the posterior fossa using the previously performed bone defect. The dura was opened and the cystic mass was followed and step wise removal achieved. Going deep the mass became more solid and vascular and it had many feeders and engulfing the left vertebral artery. All the feeders were coagulated and the cavernomatous mass dissected from the artery which was circumferentially invading it. The basilar artery was respected and all the major arteries in the area. 

Smooth postoperative recovery. The left hemiparesis regressed.

The patient came 25-December-2013 complaining of numbness of the right hand with LBP and left sciatica for 2 months. There was mild atrophy of the left side of the toque with mild weak right upper limb and dorsiflexion left foot 4/5. MRI of the brain done 28-December-2013 showing no recurrence of the mass. MRI lumbar spine showed central extrusion of L4-5 resulting in severe segmental stenosis. She was advised to undergo surgery for the L4-5 disc extrusion.

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The lesion was challenging, because the vertebral artery was engulfed by it and it had many arterial feeders.