The patient came to the clinic 25-December-2021 complaining of episodes of absences for 6 months with occurrence once per month with headache.

On examination, the patient complaining of headache and she was neurologically free. There is only exaggerated deep reflexes in the right upper limb.

The patient was sent for investigations and MRI of the brain done showing a mass in the right occipito-temporal area, multiple consistency with massive edema around it, involving the entire right hemisphere with deviation of the mid structures to the left with pending subfalcine herniation. Spectroscopy done ruling out malignant nature of the mass. It had pathological arterial feeders from the choroid plexus right posterior horn. The report was suggesting mixed solid and cystic lesion with enhancing solid component suggestive of pleomorphic xanthoastrocytoma, less likely intermediate grade astrocytoma.

In concord position with the right occipital area hanging high, using the navigation, craniotomy of the right occipito-temporal area was achieved. The dura was opened parallel to the upper edge of the transverse sinus and extended anterior to lower most of the middle fossa. The tumor was rubbery solid and the SONOCA 300 could not help removing the tumor. The tumor was rich in vascularity and it was needed to coagulate the tumor and sharp dissection was proceeded. Fresh frozen biopsy was inconclusive, but it was advised to remove the whole tumor. The vein of Labbe was identified and resection of the tumor was proceeded, so as to preserve this important vein. The boundaries of the tumor were identified and the lepto-meningial extension was considered to be removed with the solid parts of the tumor. The right posterior horn was seen and the tumor with the pathologic arteries were bisected and removed. Radical resection of the tumor was achieved and confirmed with intraoperative MRI with T1 mprage with contrast.  Strict hemostasis with preservation of all the running veins at the tentorium. The brain regained normal pulsation and relaxed. For more security, a layer of Surgicele was applied at the tumor boundaries and over the prominent veins at the tentorium. Routine closure of the wound. Smooth postoperative recovery. She was sent to the ICU for 24 hour observation.

Too early now, but the patient in the ICU 6 hours later alert and no neurologic deficit.

The final histologic result was intracerebral schwannoma with no evidence of malignancy. This case to the mentioned reference is the 12 reported case in the literature.

The patient has strange mass with such massive edema. Surgical removal was mandatory.