Summary
The degree to which a patient with sellar pathology has been neurologically affected by the lesion can be best determined with a neuro-ophthalmic examination, which traditionally includes a detailed historical assessment and physical examination. With lesions in the sellar region, the clinical neuro-ophthalmologic examination often reveals neural dysfunction because several important afferent and efferent visual pathways course near this area. The combination of neuroradiological, neuroendocrinological, and neuro-ophthalmological assessment is needed to properly manage the typical patient with a parasellar lesion. This chapter will provide an overview of the relevant anatomy and clinical neuro-ophthalmic features of lesions that affect the sellar region.
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References
Deutsch H, Kothbaur K, Persky M, Epstein F, Jallo G. Infrasellar craniopharyngiomas: case report and review of the literature. Skull Base 2001;11:121–8.
Hupp S, Kline L. Magnetic resonance imaging of the optic chiasm. Surv Ophthalmol 1991;36:207–16.
Bergland R, Ray B, Torack R. Anatomical variations in the pituitary gland and adjacent structures in 225 human autopsy cases. J Neurosurg 1968;28:93–9.
Saadati H, Hsu H, Heller K, Sadun A. A histopathologic and morphometric differentiation of nerves in optic nerve hypoplasia and Leber hereditary optic neuropathy. Arch Ophthalmol 1998;116:911–6.
Hoyt W, Luis O. The primate chiasm. Details of the visual fiber organization studied by silver impregnation techniques. Arch Ophthalmology 1963;70:69–85.
Horton J. Wilbrand’s knee of the primate optic chiasm is an artifact of monocular enucleation. Am Ophthalmol Soc 1997;95:579–609.
Lee J, Tobias S, Kwon J, Sade B, Kosmorsky G. Wilbrand’s knee: does it exist? Surg Neurol 2006;66:11–7.
Sadun A, Rubin R. The anterior visual pathways – Part II. J Neuro-ophthalmol 1996;16:212–22.
Sadun A, Schaechter J, Smith L. A retinohypothalamic pathway in man: light meditation of circadian rhythms. Brain Res 1984;202:371–7.
Frisen L. The neurology of visual acuity. Brain 1980;103:, 639–70.
Bunt A, Minckler D. Foveal sparing: New anatomical evidence for bilateral representation of the central retina. Arch Ophthalmol 1977;95:1445–7.
Gregorius F, Hepler R, Stern W. Loss and recovery of vision with suprasellar meningiomas. J Neurosurg 1975;42:69–75.
Peiris J, Ross Russell R. Giant aneurysms of the carotid system presenting as visual defect. J Neurol Neurosurg Psychiatry 1980;43:1053–64.
Swanson W, Cohen J. Color vision. Ophthalmol Clin North Am 2003;16:179–203.
Sadun A, Lessell S. Brightness-sense and optic nerve disease. Arch Ophthalmol 1985;103:39–43.
Trobe J, Tao A, Schuster J. Perichiasmal tumors: diagnostic and prognostic features. Neurosurgery 1984;15:391–9.
Stanley J, Baise G. The swinging flashlight test to detect minimal optic neuropathy. Arch Ophthalmol 1968;80:769–71.
Lagreze W-D, Kardon R. Correlation of relative afferent pupillary defect and estimated retinal ganglion cell loss. Graefes Arch Clin Exp Ophthalmol 1998;236:401–4.
Kardon R, Kawaski A, Miller N. Origin of the relative pupillary defect in optic tract lesion. Ophthalmology 2006;113:1345–53.
Frohman L, Guirgis MT, RE, Bielory L. Sarcoidosis of the anterior visual pathway: 24 new cases. J Neuro-ophthalmol 2003;23:187–9.
Bianchi-Marzoli S, Rizzo J, Brancato R, Lessell S. Quantitative analysis of optic disc cupping in compressive optic neuropathy. Ophthalmology 1995;102:436–40.
Portney G, Roth A. Optic cupping caused by an intracranial aneurysm. Am J Ophthalmol 1977;84:98–103.
Miller N, Solomon S. Retinochoroidal (optocililary) shunt veins, blindness, and optic atrophy: a non-specific sign of chronic optic nerve compression. Aust N Z J Ophthalmol 1991;19:105–9.
Sibony P, Kennerdell J, Slamovits T, Lessell S, Krauss H. Intrapapillary refractile bodies in optic nerve sheath meningioma. Arch Ophthalmol 1985;103:383–5.
Traquair H. Clinical detection of early changes in the visual field. Trans Am Ophthalmol Soc. 1939;37:158–79.
Foroozan R. Chiasmal syndromes. Curr Opin Ophthalmol 2003;14:325–31.
Mellwaine G, Carrim Z, Lueck C, Chrisp T. Amechanical theory to account for bitemporal hemianopia from chiasmal compression. J Neuro-ophthalmol 2005;25:40–3.
Hershenfeld S, Sharpe J. Monocular temporal hemianopia. Br J Ophthalmol 1993;77:424–7.
Schiefer U, Isbert M, Mikolaschek E, et al. Distribution of scotoma pattern related to chiasmal lesions with special reference to anterior junction syndrome. Graefes Arch Clin Exp Ophthalmol 2004;242:468–77.
Gittinger J. Ophthalmological evaluation of pituitary adenomas. In: Post K, Jackson I, Reichlin S, editors. The Pituitary Adenoma. New York: Plenum Medical Book Company 1980;259–86.
Chiu E, Nichols J. Sellar lesions and visual loss: key concepts in neuro-ophthalmology. Expert Rev Anticancer Ther 2006;6:S23–8.
Rosiene J, Liu X, Imielinska C, et al. Structure-function relationships in the human visual system using DTI, fMRI, and visual field testing: pre- and post-operative assessments in patients with anterior visual pathway compression. Stud Health Technol Inform. 2006;119:464–6.
Ikeda H, Yoshimoto T. Visual disturbances in patients with pituitary adenoma. Acta Neurol Scand 1995;92:157–60.
Eda M, Saeki N, Fujimoto N, Sunami K. Demonstration of the optic pathway in large pituitary adenoma on heavily weighted MR images. Br J Neurosurg 2002;16:21–9.
Shikishima K, Kitahara K, Mizobuchi T, Yoshida M. Interpretation of visual field defects respecting the vertical meridian and not related to distinct chiasmal or postchiasmal lesions. J Clin Neurosci 2006;13:923–8.
Fein J, Williams R. See-saw nystagmus. J Neurol Neurosurg Psychiatry 1969;32:202.
Kawaski A, Purvin V. Photophobia as the presenting visual symptom of chiasmal compression. J Neuro-ophthalmol 2002;22:3–8.
Lyle T, Clover P. Ocular symptoms and signs in pituitary tumors. Proc R Soc Med 1961;54:611.
Borchert M, Lessell S, Hoyt W. Hemifield slide diplopia from altitudinal field defects. J Neuro-ophthalmol 1996;16:107–9.
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Cestari, D.M., Rizzo, J.F. (2008). Neuro-ophthalmology of Sellar Disease. In: Swearingen, B., Biller, B.M. (eds) Diagnosis and Management of Pituitary Disorders. Contemporary Endocrinology. Humana Press. https://doi.org/10.1007/978-1-59745-264-9_5
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DOI: https://doi.org/10.1007/978-1-59745-264-9_5
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