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A case of unilateral oculomotor nerve palsy after arachnoid cyst surgery in a Chinese boy
小儿蛛网膜囊肿术后单侧动眼神经麻痹案
Jun WANG (汪军) , Xiao-juan SHI (侍孝娟), Dan-dan LUO (骆丹丹)Department of Rehabilitation, Children's Hospital of Fudan University, Shanghai 201102, China (复旦大学附属儿科医院康复科，上海201102，中国)
The paper reports a successful case of unilateral oculomotor palsy treated with acupuncture in a Chinese boy aged 5 years and 3 months. Filiform needles were applied for ptosis, ocular motility impairment and blurred vision of the left oculomotor palsy after arachnoid cyst surgery. Two stages of treatment with acupuncture were composed. Acupuncture in the first stage focused on resolving stasis, unblocking meridians and activating qi and blood circulation, especially at the acupoints around the eye, combined with the distal points (four gate points) to enhance qi movement and activate blood circulation, once daily. Besides, the western medicines for nerve nutrition were added. One month later, all the symptoms were alleviated, and the eyelid could be lifted. Then, the second stage of acupuncture started, during which, the western medicine for nerve nutrition was withdrawal, acupuncture was continued with the same acupoints as the first stage, once every two days. Besides, the thumb-tack needle was used to maintain the effect of filiform needle, and Zusanli (ST36) was added to replenish qi of spleen and stomach and promote circulation of meridians. Another month later, the lift of the left eyelid and the ocular motility were basically symmetrical to the right eye, and the left eye vision returned normal. Follow-up until the time of publication, the motility and function of the affected eye were basically the same as those of the healthy side. This case suggests that the staged intervention with acupuncture could be effective in child with unilateral oculomotor palsy after arachnoid cyst surgery and were acceptable for child. Further studies are needed to confirm the effect and mechanism of acupuncture intervention on postoperative oculomotor palsy. 本文报道了针刺成功治疗一例5岁3月龄小儿蛛网膜囊肿术后单侧动眼神经麻痹的临床案例。采用毫针刺法为主治疗蛛网膜囊肿术后左侧动眼神经麻痹引起的眼睑下垂、眼球活动障碍和视物不清。针刺治疗分为两个阶段，第一阶段以化瘀通络，行气活血为主，重点选取眼周腧穴，配以远端四关穴加强调畅气机, 活血通络之功，每日一次，同时辅以营养神经西药。一个月后，患儿各项症状已明显减轻，抬睑有力，针刺治疗进入第二阶段。停用神经营养西药，穴位沿用，但频率调整为隔日一次，加揿针以外治维持针刺效应，同时加针刺足三里以加强补中益气、通经活络。再一月后，患儿左侧眼睑上抬、左侧眼球活动功能与右侧基本对称，左眼视力恢复正常。随访至发稿时，患儿患侧与健侧活动和功能基本无异。这个案例提示我们分阶段针刺干预对蛛网膜囊肿术后单侧动眼神经麻痹患儿切实有效，患儿能够接受，需要进一步的深入研究来证实针刺在术后干预动眼神经麻痹疗效和机制。
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