Pilocytic astrocytoma has wide spectrum of age groups, clinical picture, anatomical location, and progression patterns. Rare unique unresectable locations in children worth analysis. Nine-year old child presented with severe hemiparesis, speech difficulties, and dystonia due to giant mesial temporal pilocytic astrocytoma, mixed solid and cystic. The rapidly progressive cyst was controlled by repeated aspiration through a stereotactically inserted Ommaya along the cyst axis. One-year later, radiosurgery was delivered for the solid part. Complete clinical cure of the patients and 86% and 74% volume reduction were achieved in the cystic and solid part, respectively, even without aspiration.