腦膜瘤術後偏癱之中西整合照護病例報告

A Case Report of Postoperative Hemiparalysis after Craniotomy for Meningioma with Integrated Treatment of Western and Traditional Chinese Medicine

10.6516/TJTCM.202109_24(3).0006

王嘉瑩(Chia-Ying Wang)；簡俊安(Jun-An Jian)；黃仲諄(Chung-Chun Huang)

開顱手術 ； 偏癱 ； 腦膜瘤 ； 中醫 ； 針灸 ； Craniotomy ； Hemiparalysis ； Meningiomas ； Traditional Chinese Medicine ； Acupuncture

中醫藥研究論叢

24卷3期（2021 / 09 / 30）

81 - 92

繁體中文

腦膜瘤是最常見的顱內原發性腫瘤，目前沒有明確治療指引，通常以手術為主，但是腦膜瘤術後新發局部神經功能缺損的機率約14.8%，新發癲癇的發生率大約12%，對於腫瘤屬於良性且無症狀的腦膜瘤患者而言，常困擾於治癒機會和手術風險之間的取捨。本病例是一名51歲女性開顱腫瘤移除手術後左側肢體偏癱，並於三個月後新發癲癇，在這段過程中持續以中藥及針灸偕同西醫共同照護，現有文獻中相對少見。文中探討急性期「辨病」的治療可能性，將術後腦組織修復過程中的炎性產物視為「痰」、「瘀」，以此為基礎處方用藥，恢復人體氣機運行；另輔以經穴與頭皮針之針灸治療，協助患者改善肢體功能進而生活自理。對於術後癲癇，此次不若西藥效果明顯，因文獻證據不足，難以確定是否病程使然。

Meningiomas are the most common primary brain tumors, however, there's no specific guideline for treatment of meningiomas compared with other tumors, and surgery seems to be the main treatment modality for meningiomas. Due to 14.8% of patients developed new focal neurological deficits, and 12% occurred new-onset seizures, weighing the risk of postoperative complications against better chances of a cure is always a dilemma for those whom were asymptomatic with a benign meningioma. This article introduces a case of a 51-year-old female with postoperative hemiparalysis after a craniotomy for meningioma and occurred new-onset seizures 3 months later, who received Western medicine and traditional Chinese medicine-includes acupuncture and herbs combined therapy during the clinical course, and is relatively uncommon in the past studies. Our prescription was based on a concept that products such as inflammatory cells during the brain tissue healing are considered as phlegm stasis, thus, we could restore human qi circulation by decreasing phlegm stasis. Meanwhile, acupuncture treatment of meridian points and scalp acupuncture had been adopted to improve limb function, furthermore, self-care ability. On the other hand, increasing the dose of Depakine seemed to be more effective in new onset seizure control compared to TCM in this case, though we cannot sure the natural course of postoperative seizures.

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