Neuro-ophthalmology of Pituitary Tumors

Abstract

The optic nerves, chiasm, and tracts lie within close proximity to the pituitary gland and sella, making vision loss a common complication of sellar region tumors. Temporal or bitemporal visual field loss, especially when associated with endocrinopathy, is highly suggestive of a pituitary tumor. Vision loss typically occurs insidiously due to the slow growth of most sellar tumors and may remain unrecognized until visual field loss is advanced. Acute vision loss can occur in some instances, such as with pituitary apoplexy. Rarely, sellar masses may also extend laterally to invade the cavernous sinuses and produce double vision owing to ocular motor neuropathies.

A neuro-ophthalmic evaluation including perimetric assessment of visual fields, evaluation for ocular motor nerve palsies, and fundus examination to detect evidence of optic neuropathy is essential for preoperative assessment and subsequent monitoring of all patients with sellar masses in close proximity to or compressing the optic nerves, chiasm, or optic tracts. Optical coherence tomography (OCT), which uses near-infrared light to produce extremely high-resolution cross-sectional images of the retina, can quantify the degree of optic nerve axonal loss, and OCT has become an important part of clinical care.