A 74 year old lady came to the clinic 19-NOVEMBER-2004 complaining of weak left upper and lower limbs for one month. The patient was operated by me 23-November-1999 for left acoustic schwannoma. She came at that time in wheelchair with inability to walk with plegia of the facial nerve left side and hearing loss. The patient had exposure keratitis at that time. Partial resection of the tumor was performed through left retromastoid approach. The patient showed considerable recovery of her gait and power of her extremities. In 01-Mart-2005 the patient was operated. Considering her age, she was put in concord position to avoid air embolism. Left transotic approach was performed and a temporo-occipital bone flap was created. The inner ear cavity was full of tumor. The facial nerve was preserved and 90% of the tumor was resected. The following points must be emphasised:

1. In old age patients the dura is severely adherent to the bone. Taking that in consideration , the sigmoid sinus was ligated below the junction with the superior petrosal sinus due to multiple tears, which were irrepairable.

2. Despite the preservation of the facial nerve, no attempt was done to cross-anastamose the nerve with other nerves, due to long time of total plegia of the facial muscles. The patient performed tarsorrhaphy 1998. The patient is not bothered with her looking. She is complaining of inability to walk.

3. The tumor was invading even the vertical and horizontal part of the ICA, but it was separable. The tentorium was involved, but all measures were taken to preserve the superior petrosal sinus. Tentoriotomy was avoided, because with experience, all the patients, to whom tentoriotomy was performed, resulted in death due to herniation of the brain by gravity and possible vascular reactions of the brain stem , several days after what could be considered successful surgery.

The patient showed prompt excellent postoperative recovery and the strength of her left side started to improve.