A 22-year-old male presented with complaints of sudden-onset blurring OU beginning 6 months ago. He was rather robust in the past. The patient recalls the onset after taking a nap in the afternoon one day. His best-corrected visual acuity was 6/6.7 in the right eye and 6/7.5 in the left eye. His eye position was orthophoric, and anterior segments were silent. Ophthalmoscopic examination showed disc edema in both eyes (Fig. 42.1). Visual field testing showed bilateral inferotemporal defects in both eyes (Fig. 42.2). A CT scan revealed a well-enhanced suprasellar lesion (Fig. 42.3). MRI showed a heterogeneous mass with cystic and solid components at the suprasellar region and third ventricular floor (Fig. 42.3). The lesion was at a retrochiasmal location, and its upward extension resulted in the compression of the right-sided foramen of Monro. He underwent a craniotomy, and his pathologic report revealed craniopharyngioma of a papillary variant. His vision recovered to 6/5 in both eyes 2.5 months postoperatively, with complete resolution of visual field defects (Fig. 42.4).
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