The patient came to the clinic 12-January-2005 complaining of convulsions for 5 months the last was 1 week ago, with headache and nausea with vomiting. MRI of the brain done 11-January-2005 showing a mass in the left sensory-motor area  7x7 cm reaching down to the sylvian cistern.

On examination: The patient is left handed. Visual functions normal, right sided hemiparesis.

Left fronto-parietal craniotomy with reflection of the flap to the ear. The dura was opened and the tumor was attacked with piece-meal resection. Subtotal resection of the tumor was achieved and the Broca area was respected. The frozen section confirmed high grade astrocytoma. Routine closure of the wound.

Smooth postoperative recovery. There is dense plegia of the right right side with sensory aphasia. The patient sent to the ICU for one day for observation.

The patient came to the clinic 23-February-2005 with still having dense plegia of the right upper limb with sensory aphasia. The proximal muscles of the upper limb start to improve and he can walk. Hoffmann and Babinski are present in the right side.

The patient then came 02-April-2005 with MRI of the brain performed 22-March-2005 showing practical radical resection of the tumor with remnants at the Broca area. The proximal muscles of the right upper limb 4/5, with plegia of the distal muscles. Can count and understand commands. No sensory deficit. Convulsion free. The patient was advised to undergo radiotherapy.

The tumor is challenging in location and for long term perspective practical maximal resection followed by radiation is the optimal solution at this period of time.