The patient came to the clinic 06-February-2012 complaining of Jacksonian motor epiattacks of right side of the body for 2 years with occasional generalization with loss of consciousness. The patient start to notice weak right upper and lower limbs for less than 6 months with progressive course.

MRI of the brain done 21-January-2012 showing diffuse mass occupying the left parietal lobe reaching the posterior horn and involving the left sensori-motor strip and reaching the splenium. The condition of the patient is deteriorating rapidly and he got major 2 attacks in the last following days.

On examination: the patient has profound weak right upper and lower limbs with 3/5 weak distal muscles and 4/5 proximal muscles. In Romberg position, the right upper limb sway down. There is no sensory deficit.

The Z point was identified and 4 cm behind and 6 cm lateral off the midline to the left, a burr hole was done. The dura was opened in x-fashion. The tumorous cortical layer was identified. Using ISIS HighLine neurophysiologic control, the cortex was stimulated to be sure, that the motor area is not shifted far posterior. There is no response, even at 5-6mA DNS. HS was also used with bipolar stimulation. The cortex was sharply incised and using small tiny forceps, 4 pieces were obtained from 4 different locations with various angles with depth of 25 mm.

Routine closure of the wounds. Smooth postoperative recovery.

The patient had convulsions for 2 years and no doctor asked for MRI until the patient himself asked for MRI of the brain. It is mandatory to perform MRI of the brain with contrast for all patients with epilepsy, especially patients with Jacksonian marsh.

Here the biopsy was performed with electrophysiological control to avoid functionally important cortical areas. Using ISIS with cortical stimulation is the ideal method in this case.