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21-APRIL-2009  SAYF EDDIN YAHIYA AL-MUFTY  76 YEARS  HIGH GRADE ASTROCYTOMA RIGHT OCCIPITO-PARIETAL WITH APOPLEXY 05-APRIL-2009.

Anamnesis:

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The patient was admitted to Shmaisani hospital 20-April-2009 with history of sudden onset deterioration with admission to other hospital and subsequent left side hemiplegia.

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The patient is a known diabetic with hypertension and he underwent several stents for coronary disease and Larische syndrome.

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MRI performed 05-April-2009 showed a tumor at the medial parts of the right occipito-parietal region. The patient continued to deteriorate and MRI of the brain performed 06-April-2009 showed the tumor with apoplexy inside and outside the tumor. MRI of the brain performed 19-April-2009 showed the tumor with massive perifocal oedema with resolution of the outside hematoma.

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On examination: the patient is drowsy and hallucinating with dense left sided plegia with some movement of the left hand and at times obeying commands.

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Craniotomy at the right occipito-parietal region was performed with reflection of the bony flap down to the ear. The dura was opened parallel to the occipital edge of the bone defect. The hemorrhagic tumor was reaching the surface of the cortex, for what, transcortical approach was performed between tow major running veins. The clot was evacuated and the tumorous tissue was removed in piece-meal fashion. Subtotal resection of the mass and total resection of the surely looking tumor was achieved. There was 20X20 mm defect in the bed of the tumor through which the falx cerebri was seen. The posterior horn of the lateral ventricle was reached. Anatomical preservation of the sensory strip and the optic radiation was considered during resection.  The histological result was that of high-grade astrocytoma. Strict heamostasis with applying the surgicel in the tumor cavity. Water-tight closure of the dura and routine closure of the wound.

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Smooth postoperative recovery and the patient sent to the ICU without ventilation.

Comments

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The patient had mostly malignant tumor which progressed hemorrhage. This fact push to the malignant nature of the tumor.

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The next step is radiation combined with temodar treatment. Gliadel wafers could be an option for younger patients.

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