The patient came to the clinic 06-September-2003 complaining of huge mass in the left supra and subclavicular region with extension to the upper half of the left chest cavity. He was operated 1994 in Irbid and reported as having schwannoma.

On examination, the patient has severe weak deltoid, biceps brachii brachioradialis and flexion with extension left hand 3/5. Analgesia all the left upper limb except the ulnar division of the left hand. The mass elevating the left pectoralis muscles.

Supra-infraclavicular incision over the mass. The pectoralis muscles were splitted to expose the mass. The boundaries of the mass were followed and huge pieces were resected under the muscles. After removal of the huge mass there are a lot of masses involving the brachial plexus, subclavian artery and vein. The artery and veins could preserved, but dirt of the tumor was lift around them embedded in their walls. The brachial plexus was completely destroyed by the tumor, that removal of the masses means removal of the neural structures. Waiting the frozen biopsy result was malignant neural sheathe sarcoma. It was decided to be more aggressive and remove as maximally radical as could be. The normally looking neural structures were dissected proximal and distal to the lesion and resected. Direct anastamoses was performed between them. The operation was long and huge blood loss was noted. Routine closure of the wound. Smooth postoperative recovery. The power of the left upper limb dramatically deteriorated.

The patient came to the clinic 25-September-2003 with clean wound and the power of the left deltoid is 1/5 all other muscles 0/5 except the flexion of the left hand 4/5. The patient was advised to undergo radiation and chemotherapy.

The patient then came the last time 20-September-2004 telling that he felt down 30-August-2004 and got fracture upper third right femur and nailing was performed. He was in chemotherapy for 10 months after our surgery. MRI of the chest showing wide-spread metastasis with left shoulder is full of metastasis . He did not perform radiation. He has hemoptysis and dysphonia. He has edema both legs and the left upper limb with weak pulse. The patient sent for brain MRI investigation, but he did not return.

It is a huge price to bisect the brachial plexus to achieve radical resection. Misleading biopsy results from previous surgery made this wrong decision to operate such a case.