Abstract
Purpose
To evaluate pathogenetic mechanisms and frequency distribution of visual field defects (VFDs) in patients with chiasmal lesions. Secondly, to reconsider the existence of “Wilbrand’s knee” as far as referable to the anterior junction syndrome.
Methods
Consecutive visual field records related to chiasmal lesions were retrieved from the Tuebingen Perimetric Database. In all cases, at least one eye was examined with the Tuebingen Automated Perimeter using a standardized grid of 191 static targets within the central 30° visual field, and a threshold-related, slightly supraliminal strategy. VFDs were classified according to standard neuro-ophthalmological categories.
Results
Results from 153 consecutive patients (65 male, 88 female) were evaluable. The majority (65%) of chiasmal lesions was due to pituitary adenoma, followed by craniopharyngioma (12%), astrocytoma (9%), and meningioma (8%). Vascular lesions in this region occurred rarely (2%). Three per cent of all patients had no final diagnosis. The majority (22%) of scotomas was attributable to involvement of the temporal hemifield in both eyes, with true bitemporal hemianopia being a very rare event (1%). Anterior junction syndrome, characterized by advanced visual field loss affecting the visual field centre in one eye and (possibly subtle) defects respecting the vertical midline in the fellow eye, was the second most frequent classifiable VFD (13%). Homonymous hemianopic VFDs occurred in 11% of all cases. Nine per cent of all patients exhibited monocular VFDs which did not respect the vertical midline, whereas in 3% of the subjects the monocular VFDs did not cross the vertical meridian. Binasal defects and posterior junction syndrome also occurred seldom (<1%). Nineteen per cent of all visual field records of patients with chiasmal lesions had results, which could not be classified unequivocally, and an identical portion was rated normal.
Conclusion
In patients with chiasmal lesions, incomplete involvement of the temporal hemifields in both eyes was the most frequent event (22%), followed by anterior junction syndrome (13%). The latter entity at least clinically indicates the proximity of the pre-chiasmal ipsilateral optic nerve and decussating fibres emanating from the inferior nasal hemiretina of the fellow eye. However, this cannot provide conclusive evidence for the existence of anterior Wilbrand’s knee.
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References
Alvarez-Bolado G, Schwarz M, Gruss P (1997) Pax-2 in the chiasm. Cell Tissue Res 290:197–200
Apkarian P, Eckhardt PG, van Schooneveld MJ (1991) Detection of optic pathway misrouting in the human albino neonate. Neuropediatrics 22:211–215
Apkarian P, Bour LJ, Barth PG, Wenniger-Prick L, Verbeeten B Jr (1995) Non-decussating retinal-fugal fibre syndrome. An inborn achiasmatic malformation associated with visuotopic misrouting, visual evoked potential ipsilateral asymmetry and nystagmus. Brain 118:1195–1216
Aulhorn E (1974) Gesichtsfeldausfälle bei sellären und parasellären Prozessen. Ber Zusammenkunft Dtsch Ophthalmol Ges :7221–7229
Aulhorn E, Harms H (1972) Visual perimetry. In: Autrum H, Jung R, Loewenstein WR, Mackay C, Teuber HL (eds) Handbook of sensory physiology Vol. VII/4 Visual Psychophysics. Springer, Berlin, pp 102–145
Bajandas FJ, Kline LB (1988) Neuro-Ophthalmology Review Manual. Slack, Thorofare, USA
Bear CA, Kerrison JB, Lynn M, Newman SA, Newman NJ (2000) Stages of improvement in visual fields following pituitary tumor resection. Invest Ophthalmol Vis Sci 41 [Suppl]:313
Biousse V, Mendicino ME, Simon DJ, Newman NJ (1998) The ophthalmology of intracranial vascular abnormalities. Am J Ophthalmol 125:527–544
Birgbauer E, Oster SF, Severin CG, Sretavan DW (2001) Retinal axon growth cones respond to EphB extracellular domains as inhibitory axon guidance cues. Development 128:3041–3048
Blamires TL, Reeves BC (1996) Vision defects in patients with peri-chiasmal lesions. Optom Vis Sci 73:572–578
Burde RM, Savino PJ, Trobe JD (1992) Clinical decisions in neuroophthalmology. Mosby, St. Louis
Bynke H (1986) Pituitary adenomas with ocular manifestations. Neuroophthalmology 6:303–311
Dannheim F (1977) Perimetrie beim Chiasmasyndrom, schwellennahe und überschwellige Reize. Klin Monatsbl Augenheilkd 171:468–477
Deliganis AV, Geyer JR, Berger MS (1996) Prognostic significance of type 1 neurofibromatosis (von Recklinghausen disease) in childhood optic glioma. Neurosurgery 38:1114–1118
Dureau P, Attie-Bitach T, Salomon R, Bettembourg O, Amiel J, Uteza Y, Dufier JL (2001) Renal coloboma syndrome. Ophthalmology 108:1912–1916
Freitag H-J, Grzyska U, Zeumer H (1990) Möglichkeiten der interventionellen Neuroradiologie. Dt Ärzteblatt 87:23–27
Gittinger JW (1998) Tumors of the pituitary gland. In: Miller NR, Newman NJ (eds) Walsh & Hoyt’ s clinical neuro-ophthalmology. Williams & Wilkins, Baltimore, pp 2142–2221
Glaser JS (1990) Neuro-ophthalmology, 2nd edn. Lippincott, Philadelphia
Groden C, Freitag H-J (1998) Fortschritte in der ophthalmologischen Neuroradiologie. Z Prakt Augenheilkd 19:29–32
Gruss P, Walther C (1992) Pax in development. Cell 69:719–722
Guillery RW (1991) Rules that govern the development of the pathways from the eye to the optic tract in mammals. In: Lam DM, Shatz CJ (eds) Development of the visual systems. MIT Press, Cambridge, Massachusetts, pp 153–171
Guillery RW, Okoro AN, Witkop CJ Jr (1975) Abnormal visual pathways in the brain of a human albino. Brain Res 96:373–377
Guillery RW, Mason CA, Taylor JSH (1995) Developmental determinants at the mammalian optic chiasm. J Neurosci 15:4727–4737
Hollenhorst RW, Younge BR (1973) Ocular manifestations produced by adenomas of the pituitary gland: analysis of 1000 cases. In: Kohler PO, Ross GT (eds) Diagnosis and treatment of pituitary tumors. American Elsevier, New York, pp 53–68
Holmes JM, Droste PJ, Beck RW (1998) The natural history of acute traumatic sixth nerve palsy. Invest Ophthalmol Vis Sci 39 [Suppl]:153
Horton J (1995) Wilbrand’s knee 1904–1995: R.I.P. In: Hoyt WF (ed) An update in neuro-ophthalmology. UCSF, San Francisco, California, pp 27–38
Hoyt WF, Luis O (1962) Visual fiber anatomy in the infrageniculate pathway of the primate. Arch Ophthalmol 68:94–106
Huber A (1977) Chiasmasyndrome: Klinik. Klin Monatsbl Augenheilkd 170:266–278
Huber A (1988) Homonyme Hemianopsie bei Hirntumoren. Klin Monatsbl Augenheilkd 192:543–550
Huber A, Kömpf D (1998) Klinische Neuroophthalmologie. Thieme, Stuttgart
Ikeda H, Yoshimoto T (1995) Visual disturbances in patients with pituitary adenoma. Acta Neurol Scand 92:157–160
Jansonius NM, van der Vliet TM, Cornelissen FW, Pott JW, Kooijman AC (2001) A girl without a chiasm: electrophysiologic and MRI evidence for the absence of crossing optic nerve fibers in a girl with a congenital nystagmus. J Neuroophthalmol 21:26–29
Jeffery G (2001) Architecture of the optic chiasm and the mechanisms that sculpt its development. Physiol Rev 81:1393–1414
Koshiba-Takeuchi K, Takeuchi JK, Matsumoto K, Momose T, Uno K, Hoepker V, Ogura K, Takahashi N, Nakamura H, Yasuda K, Ogura T (2000) Tbx5 and the retinotectum projection. Science 287:134–137
Kupersmith MJ, Straga J, Zeiffer B, Kraker R (2001) Junctional scotoma in acute optic neuritis or inflammation of the ‘knee’. Invest Ophthalmol Vis Sci 42 [Suppl]:326
Lachenmayr BJ, Buser A (1993) Refraktion und Gesichtsfeld. Der Augenarzt 27:114–120
Lagrèze WA, Kommerell G (2002) Gesichtsfeldausfälle. In: Kampik A, Grehn F (eds) Augenärztliche Differentialdiagnose. Thieme, Stuttgart, pp 160–168
Legouis R, Cohen-Salmon M, Del C, I, Petit C (1994) Isolation and characterization of the gene responsible for the X chromosome-linked Kallmann syndrome. Biomed Pharmacother 48:241–246
Lim WK, Aung T, Foster PJ, Seah SK, Wu HM, Lim ATH, Lee L, Chew SJ (2000) The visual field in eyes with tilted optic discs. Invest Ophthalmol Vis Sci 41 [Suppl]:284
Manor RS, Ouaknine GE, Matz S, Shalit MN (1980) Nasal visual field loss with intracranial lesions of the optic nerve pathways. Am J Ophthalmol 90:1–10
Miller NR (1988) Walsh and Hoyt’s clinical neuro-ophthalmology, Vol 3. Williams & Wilkins, Baltimore
Miller NR (1991) Walsh and Hoyt’s clinical neuro-ophthalmology. Vol. 4. William & Wilkins, Baltimore
Müller M, Holländer H (1988) A small population of retinal ganglion cells projecting to the retina of the other eye. An experimental study in the rat and the rabbit. Exp Brain Res 71:611–617
Oster SF, Sretavan DW (2003) Connecting the eye to the brain: the molecular basis of ganglion cell axon guidance. Br J Ophthalmol 87:639–645
Sachsenweger R (1982) Tumoren des 3. Ventrikels. In: Neuroophthalmologie. Thieme, Stuttgart, pp 130–131
Schatz NJ, Schlezinger NS (1976) Noncompressive causes of chiasmal disease. In: Burde RM (ed) Symposium on neuro-ophthalmology. Mosby, St. Louis pp 91–97
Schiefer U, Wilhelm H (1995) Gesichtsfeld-Kompendium. Klin Monatsbl Augenheilkd 206:206–238
Schwarz M, Cecconi F, Bernier G, Andrejewski N, Kammandel B, Wagner M, Gruss P (2000) Spatial specification of mammalian eye territories by reciprocal transcriptional repression of Pax2 and Pax6. Development 127:4325–4334
Silver J (1984) Studies on the factors that govern directionality of axonal growth in the embryonic optic nerve and at the chiasm of mice. J Comp Neurol 223:238–251
Stangel M, Vogeley KT, Jandeck C, Boegner F, Marx P, Koch HC (1998) Septooptische Dysplasie (de-Morsier-Syndrom). Nervenarzt 69:352–356
Thanos S (1999) Genesis, neurotrophin responsiveness, and apoptosis of a pronounced direct connection between the two eyes of the chick embryo: a natural error or a meaningful developmental event? J Neurosci 19:3900–3917
Trobe JD, Tao HH, Schuster JJ (1984) Perichiasmal tumors: diagnostic and prognostic features. Neurosurgery 15:391–399
Viggiano D, Pirolo L, Cappabianca S, Passiatore C (2002) Testing the model of optic chiasm formation in human beings. Brain Res Bull 59:111–115
Walsh TJ (1996) Visual fields. Examination and interpretation, 2nd edn. American Academy of Ophthalmology, San Francisco
Wilbrand HL (1926) Schema des Verlaufs der Sehnervenfasern durch das Chiasma. Z Prakt Augenheilkd 59:135–144
Wilbrand H, Saenger A (1904) Die Neurologie des Auges. Bergmann, Wiesbaden
Williams RW, Borodkin M, Rakic P (1991) Growth cone distribution patterns in the optic nerve of fetal monkeys: implications for mechanisms of axon guidance. J Neurosci 11:1081–1094
Yuanxiu L, Hua G, Yong Z (1994) Vascular architecture of the human optic chiasma and bitemporal hemianopia. Chin Med Sci J 9:38–44
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Schiefer, U., Isbert, M., Mikolaschek, E. et al. Distribution of scotoma pattern related to chiasmal lesions with special reference to anterior junction syndrome. Graefe's Arch Clin Exp Ophthalmol 242, 468–477 (2004). https://doi.org/10.1007/s00417-004-0863-5
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DOI: https://doi.org/10.1007/s00417-004-0863-5