中醫針藥治療聽神經瘤手術後遺腦神經功能損傷與預防腦腫瘤復發之探討

聽神經瘤為良性居多、且生長速度緩慢的腦腫瘤，初期僅有耳鳴、眩暈、單側聽力退化、頭痛等症狀，不容易早期診斷，多是等到腫瘤過大壓迫小腦或腦幹，出現臉部感覺麻痺、步態不穩甚至口眼歪斜時，才於檢查後確診。大於3cm的聽神經瘤，開顱手術為治療首選，但因腫瘤緊密包覆聽神經異常生長，術中要保留神經功能難度甚高，且術後容易造成開刀部位的腦內外積液，故常見聽神經、三叉神經、顏面神經以及與眼睛活動相關之腦神經後遺損傷，造成病患面癱、眼球共軛運動障礙，嚴重影響日常生活，近來已有加馬刀、電腦刀等放療加入西醫治療行列，對於治療<3cm的聽神經瘤使之縮小，可謂立竿見影，但副作用與日後復發機率仍高。

關鍵字

聽神經瘤；腦神經損傷；腦腫瘤中醫治療；顏面神經針灸

並列摘要

Acoustic Neuroma usually presents as a benign and slow-growing brain tumor. The initial stage generally manifests as tinnitus, vertigo, unilateral hearing loss, and headache. These signs and symptoms are not specific and might interfere with early diagnosis. Patients usually get a confirmed diagnosis when the tumor growth starts to compress cerebella and brain stem or when the patient shows facia paresthesia, imbalanced gait, or facial paralysis. Craniotomy for acoustic neuroma is the first line of treatment for tumor sizes greater than 3cm. However, craniotomy can lead to challenges such as preserving the nerve function due to the abnormal growth of tumors covering the acoustic nerve or post-operative intracranial or extracranial fluid retention, etc. Therefore it's common to see post-operative damage on the acoustic nerve, trigeminal nerves, facial nerves, and nerves related to eye movement. The complication can lead to facial paralysis and eye-conjugated movement disorder, which can be deblitating to the patients. Recently, applying Gamma knife and cyber knife in acoustic neuroma surgery can effectively treat tumor sizes of less than 3cm. However, we still see a high recurrency and complication regardless of the surgery.