The patient an Iraqi citizen came to the clinic 14-June-2004  after performing to him removal of the low grade glioma IV ventricle 23-March-2004. The first surgery ran without complication and came to remove the left lesser with meningioma.

On examination: the patient is walking with help. Romberg was unable to evaluate. Horizontal nystagmus both side. Right side paresis with right facial nerve paresis. Sensation not affected. Dysphonia with hypotrophy of the right side of the tongue. The hearing right ear became worse.

The patient was sent for thorough investigations and MRI done 16-June-2004 of the brain showed left lesser wing meningioma involving the left cavernous sinus and separate left subtentorial meningioma, pushing the brain stem to the right, right acoustic schwannoma with intracanalicular extension pushing the brain stem to the left with scattered small foci in the brainstem and cerebellar hemispheres. The patient has manifestations of neurofibromatosis.

Left pterional approach with detachment of the bone flap from the muscle to prevent possible postoperative extradural hematoma. Drilling of the pterion so as to have near access to the tumor. The subarachnoid spaces were violated to promote CSF leak and decrease the volume of the brain and decrease the traction effect. The tumor was seen and coagulation and piece meal resection of the tumor was undertaken. The involved bony parts of the tumor from the destroyed lesser wing were removed. The dural matrix was removed. Total resection of the meningioma was achieved. Fresh frozen result was meningioma. Strict hemostasis. Routine closure of the wound. Smooth postoperative recovery. The patient was sent to the ICU for 3 days observation.

The patient came to the clinic 25-October-2004 with clean wound and the paresis in the right side increased. The power of the lower limbs still the same. The patient was sent for investigations, but he disappeared.

The patient has long way with his tumors. They need several approaches and the mortality rate for these lesions is high.

He underwent 2 major surgeries and it was planned to remove the right acoustic schwannoma as third stage, then the left CPA tumor as the last stage, but he disappeared.