The patient a Yemeni citizen, came to the clinic 06-Sptember-2003 complaining headache for more than 5 years with decreased vision for 4 months with ataxia with left hemiparesis with convulsions and fainting and nausea attacks.

On examination: the patient has practical blindness both eyes and can see near objects 10 cm  with guising. When looking up the left eye shift to the left. Profound deep left hemiparesis.

The patient sent to perform MRI of the brain, which was done and showing huge mass in the right parieto-occipital region deeply seated down reaching the right thalamus and occupying the medial wall of the right inferior horn pushing the pineal body to the left side, occupying the right posterior horn, pushing the deep cerebral veins inferior and backward having carpet in the right tentorium. There is edema of the cortex overlying the lesion.

Wide osteoplastic craniotomy over the right occipito-parietal region with reflection of the flap to the right ear. The dura was opened circumferentially to expose wide area of the cortex. Looking for adequate area. transcortical approach was performed and the tumor was seen 8 mm below the cortical surface. Piece-meal resection of the tumor was proceeded and fresh frozen section was malignant meningioma. Total resection of the tumor was achieved using the landmarks of the right inferior horn, the right posterior horn, the III ventricle  and the tentorium. The tumor was with different consistency with rubbery elements and violate-bluwish in color. The choroid plexus of the involved ventricular parts was preserved. The matrix of the tumor in the tentorium was coagulated. Respect to all surrounding normal brain tissues around the tumor with preservation of the important arteries and veins. Strict hemostasis.

Routine closure of the wound. Smooth postoperative recovery. The patient was extubated and sent to the ICU for 24 hours observation.

The patient came to the clinic 23-September-2003 with clean wound and the power of the right side with slight improvement, but the visual functions still the same.

The patient has tentorial carpet and meningioma was suspected before surgery, for what aggressive total resection was achieved.