The patient came to the clinic 09-September-2012 complaining of neck pain for 2 weeks with left shoulder pain with numbness of the ulnar division left side with headache and fainting attacks with numbness of the left foot. The patient was operated by me 12-June-1999 for schwannoma of the left ulnar nerve at the lower third of the arm. He has squint due to right VI nerve palsy since childhood. CABAG was done 2 years ago.

On examination: Romberg -stable. There is neck pain when looking to the right and upward. He has occasional sensory motor marsh of the left lower limb.

The patient was sent for MRI of the brain with contrast  and cervical spine, which were done 10-October-2012 and repeated 01-November-2012 showing huge mass in the right occipital lobe mostly oligodendroglioma with huge PCD C5-6 with left foraminal occlusion. The radiologist reported the occipital mass as it is a tuberculoma.

Right occipital craniotomy was done to include in the field the posterior third of the SSS  and the right transverse sinus. The brain was tense, for what the dura was opened 4 mm parallel to the right transverse sinus. The tumor has variable consistency with good cleavage with abnormal vessels running inside the tumor mass. It was highly vascular in some places and avascular in others. It was adherent to the tentorium and the transverse sinus and confluence sinuum and SSS. It was separated from these structures and the tentorium was seen in wide base. The tumor was sent for frozen biopsy which ruled out tuberculoma and suggesting high grade glioma. The tumor was totally resected, because it had good cleavage. No attempt was paid to violate the posterior horn, so as to avoid CSF seeding in case of possible glioblastoma multiforme result. Heamostasis with water-tight closure of the dura.

Routine closure of the wound. Smooth postoperative recovery.

The patient has short history with this good cleavage tumor which was removed totally. In CT-scan and MRI the mass is resembling tuberculoma, but its consistency was demonstrating a gliomatic with aggressive behavior mass.

The histologic result gave a hint that the patient mostly have a metastatic nature of the lesion, for what CT-scan of the chest and abdomen were done 06-December-2012 which showed a nidus in the lower lobe right lung and scattered involvement of the liver.