|Year : 1971 | Volume
| Issue : 1 | Page : 14-17
Some observation on visual function in 204 sellar lesions
B Ramamurthy, TS Kanaka
Department of Neurosurgery, Madras Medical College, Madras, India
Department of Neurosurgery, Madras Medical College, Madras
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Ramamurthy B, Kanaka T S. Some observation on visual function in 204 sellar lesions. Indian J Ophthalmol 1971;19:14-7
With the advancement of neurological sciences, the science of neuro-ophthalmology has achieved great importance. This is a field in which the neurosurgeons and ophthalmologists have to cooperate closely to give the best benefit to the patients. This paper is a tribute to the greatness of an Institution which is celebrating 150 years of its service in the field of ophthalmology. I am grateful to the organisers of the 150th Anniversary Celebrations of the Government Ophthalmic Hospital, Madras for having invited me to take part in the Scientific Session. At this moment it is but right that one's thoughts should turn to the great traditions of this, institution and the pioneers in ophthalmology who have made this institution famous.
During the past twenty years in close collaboration with the Department of Neurology and Neurosurgery, of the General Hospital, Madras, the Science of Neuro-ophthalmology has come into being. Despite the association of a leading ophthalmic hospital and an active neurosurgical centre, the science of neuroophthalmology has not yet achieved its rightful place. Looking back into the publications of the past decade, we would find that scientific publications on Neuroophthalmology have been few and far between.
This has been partly corrected by the creation of the post of a neuro-ophthalmologist at the Madras Medical College. The overload of work and patients in this hospital is well known but the great name already achieved could be maintained only by diversifying our interest and beginning to specialise and concentrate on different problems.
One can remember the day when a large number of blind patients were referred from eye hospitals to neurosurgical units. These patients had advanced intracranial tumours; many of them came with a diagnosis of pituitary tumour because the x-rays showed enlarged pituitary fossa. Often this enlargement was due to an enormously dilated third ventricle caused by a lesion in the posterior fossa. Since those days we have progressed to highly sophisticated investigations like electroencephalography, angiography, echoencephalography and fractional pneumoencephalography to help us in determining the various lesions that occur near the optic chiasma. In a monograph published ten years ago the pituitary lesions encountered in our department were studied and conclusions drawn. This has now been brought upto-date and our experience of lesions occuring around the sella is being presented.
Lesions of the Chiasma like trauma, arachnoiditis, aneurysms, glial tumours of the chiasma and III ventricle tumours are not included in this series. Parasellar lesions like aneurysm of the carotid artery and meningiomas are also not included.
204 sellar lesions are presented. [Table - 1] shows the incidence of each variety of lesion.
A comparison of visual field loss in Chromophobe adenomas, acromegaly and in cranio pharyngiomas shows the different ways in which these various lesions affected the visual pathway. Of the 103 cases of chromophobe adenomas it is seen that there were only 4 cases that reported with no field loss. There were 18 cases that were blind in both eyes and 30 cases that were blind in one eye atleast. These figures reflect the late stage in which the patients get referred to the neurosurgical department for definitive treatment.
It is also clear from the table that classical bitemporal hemianopia is seen only in one third of the group of the cases. It may be because many of them might have passed through this stage without the defect being either appreciated by the patient or recognised by the doctor. It is also interesting to note that five patients were blind only in one eye with a normal opposite eye and one patient had hemianopia. This would indicate that the tumour was spreading in a bizarre fashion. Extending anteriorly and laterally only, the tumour may press on one optic nerve alone. Extending posteriorly the tumour may cause hemianopia by pressure on the optic tract.
In acromegaly 12 out of 27 patients had normal fields. This is as expected as the endocrine symptoms start to manifest, much earlier than the signs of visual compression.
In craniopharyngiomas the tumour tends to grow into the 3rd ventricle and cause papilloedema. Thus 23 out of 50 patients came late with blindness. Depending on the spread of the lesion cranio-pharyngiomas also can cause different types of field defects.
The next 3 tables show the ophthalmoscopic findings in the 3 different varieties of tumours.
Commonly either pallor or optic atrophy was seen in adenomas of the pituitary gland. Five chromophobe adenomas presented with the uncommon findings of bilateral papilloedema, while five presented with a Foster Kennedy syndrome.
In acromegaly 12 out of 27 patients presented with the normal fundus appearance. This may happen even when the x-ray of the skull shows the enlargement of the sella and the typical appearance of acromegaly.
In cranio pharyngiomas 14 patients had bilateral papilloedema and 8 patients had post papilloedemic optic atrophy.
Thus the above figures show the present stage of recognition of pituitary tumours in India. Many of the patients when they discover any ophthalmologic difficulty went to the oculist instead of a doctor. Even in some instances, where the patient went to the Ophthalmologist, glasses were prescribed and the fields were not examined. I am sure that with the greater awareness of the presence of pituitary lesions amongst us the ophthalmologists, despite all the excess load of work will find enough time to devote to Neuro Ophthalmological problems.
[Table - 1], [Table - 2], [Table - 3], [Table - 4], [Table - 5], [Table - 6], [Table - 7]