The Glioblastoma multiforme is the most malignant brain tumor. The prognosis is gloomy.

At the present time, I will not operate the patient with Glioblastoma multiforme without proper MRI and MR Spectroscopy and Fibertraking and intraoperative MRI monitoring and electrophysiological control and to have in advance Gliadel wafers and seeds for brachytherapy. With these measures you can elevate the postoperative life expectancy for around 5 years as in the future surgeries. (06-May-2021).

The patient was brought to the clinic 11-December-2002 complaining of right sided plegia, motor and sensory aphasia for one month. The condition is rapidly deteriorating with nausea and vomiting. She had hearing loss right ear for long time. MRI with contrast showing huge mass left fronto-temporal lobes extending deep to involve the mediobasal temporal lobe and sensory auditory area  and the left internal capsule with massive edema shifting the midline structures to the right. PET was done showing no tracer activity. There is enlargement of the right lobe of the thyroid gland. The patient was put in medications to improve her condition and repair for surgery.

On examination: The patient is not responding to verbal command, nor speaking. Dense right sided plegia.

Wide left osteoplastic craniotomy over the left frontal and temporal lobes. The dura opened parallel to the bony edges and with the bony flap reflected to the ear. The Sylvian cistern identified and the motor strip , Broca area and the sensory auditory area also identified. It was decided to attack the tumor first through the temporal lobe, then transcortical prefrontal and piece-meal resection of the tumor was performed. Fresh frozen biopsy gave the result of Glioblastoma multiforme. After that it was decided to remove as possible as can permit, so as avoid loosing the patient in operating room. The tumor was attacked through the temporal lobe away from the sensory auditory area and resection was performed with preservation of the MCA branches. It was possible to see the olfactory tract running at the base. Alternative resection was performed from these two approaches. The swollen brain collapsed and pulsating and CSF coming from the Sylvian and prechiasmatic cistern. It was possible to see the left optic nerve running under the olfactory tract. Strict hemostasis and  routine closure of the wound.

Smooth postoperative recovery. The neurological status still the same . She was sent to the ICU for strict observation.

The patient was sent for radiotherapy and chemotherapy.

The final histologic result was Glioblastoma multiforme. ( Dr. Hussam Abu-Farsakh, M.D.)