小腦橋腦角腫瘤採觀察策略的12年追蹤：個案報告

Twelve-Year Follow-Up Observation for Cerebellopontine Angle Tumors: Case Report

連恩欣(En-Hsin Lian) ； 許筱曼(Hsiao-Man Hsu) ； 林鴻清(Hung-Ching Lin)

《台灣聽力語言學會雜誌》 44期 (2021/06) Pp. 77-85

https://doi.org/10.6143/JSLHAT.202106_(44).0004

摘要

本文擬介紹一名小腦橋腦角腫瘤採觀察策略個案。54歲男性，2008年時診斷左側小腦橋腦角腫瘤，至2020年長達12年的觀察，定期核磁共振（magnetic resonance imaging, MRI）追蹤腫瘤成長速度，輔以純音聽力檢查（pure-tone audiometry, PTA）。2008年主訴左側耳鳴、聽力減退合併暈眩，PTA顯示不對稱性聽力損失，左耳高頻陡降型感音神經型聽力損失，程度輕度至中度（mild to moderate）。聽覺反射閾值異常（左耳對側消失），神經診斷聽性腦幹反應（neurodiagnostic auditory brainstem response, nABR）雙耳V波潛時差值為0.36 ms，後影像學診斷為左側小腦橋腦角腫瘤，內聽道腫瘤侵犯整個內聽道，未經治療。2020年，左側持續耳鳴，純音均值（0.5、1.0、2.0、4.0 kHz）從28.75 dB hearing level（HL）惡化為47.50dB HL，為15 mm腫瘤併整個內聽道侵犯。觀察時間長，尤其針對腫瘤增長和聽力變化，提出供臨床人員討論。

關鍵字

小腦橋腦角腫瘤 ； 觀察等待 ； 保守治療

並列摘要

This article introduces a case of cerebellopontine angle tumor (CPA) who accepted watchful waiting instead of immediate treatment. A 54-year-old man was diagnosed with left CPA in 2008, and has been observed until 2020, including follow-up magnetic resonance imaging (MRI) and audiometry. In 2008, he complained of dizziness and left side hearing loss accompanying with tinnitus. Examination revealed asymmetric hearing loss with left ear having mild to moderate sloping high-frequency sensorineural hearing loss (SNHL). The acoustic reflex threshold was abnormal (right ear contralateral acoustic reflexes were absent), and the interaural wave V latency difference was 0.36 ms in the neurodiagnostic auditory brainstem response. MRI has shown a nodular lesion in left internal acoustic canal thus he was diagnosed with left CPA which filling the entire internal auditory canal. In 2020, tinnitus persists at left ear, and the average pure tone (0.5, 1.0, 2.0, 4.0 kHz) threshold in the left ear deteriorates from 28.75 to 47.50 dB hearing level (HL), the longest diameter of the tumor is 15 mm with the invasion of the internal acoustic canal. Since a long period of observation of tumor growth and hearing changes, this case is worthy of discussion.

並列關鍵字

Cerebellopontine angle tumor ； Watchful waiting ； Conservative management

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