The patient came to the clinic 19-November-2003 complaining of headache more the right parietal region with convulsions for 50 days with heaviness of the head with insomnia. MRI of the brain done 06-November-2003 showing a mass in the left frontal lobe.

On examination: The patient is right handed. Romberg stance stable. Left hemiparesis with Babinski and Hoffman signs positive left side.

Wide osteoplastic craniotomy over the right frontal region with reflection of the flap to the right ear. The dura was opened and the cortex inspected for more safe transcortical approach. The tumor was identified and fresh frozen result was of low grade astrocytoma. Using the anatomical landmarks the resection was proceeded until the falx cerebri was seen and the branches of ACA were preserved. The dissection was done down with preservation of the olfactory tract. The dissection was followed posteriorly until the the anterior horn was reached. Inspection for remnant of the tumor in the cavity for pathologic tumorous changes were negative. Practical radical resection of the visible either in the MRI or visual control was achieved. The brain is lax and pulsating. Strict hemostasis with routine closure of the wound.

Smooth postoperative recovery and the patient was sent to the ICU for 24 hours observation.

The patient came to the clinic 25-December-2003 with clean wound and neurologically free. He was advised to undergo radiation.

The patient came 21-August-2004 with new MRI done 12-August-2004 showing no recurrence of the tumor. Convulsion free, but kept in Epanutin. He underwent radiation.

The patient then came 07-January-2009 10 day after exposing to RTA. MRI of the brain done 23-August-2007 showing no recurrence of the tumor with one convulsion. He was put back in Epanutin. MRI brain done 07-January-2009 showing malacia of both frontal lobes with possible regrowth or radionecrosis. He was advised to undergo chemotherapy. The patient then disappeared.

The final histologic result was low grade astrocytoma.