Indian Journal of Ophthalmology

: 1971  |  Volume : 19  |  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

Correspondence Address:
B Ramamurthy
Department of Neurosurgery, Madras Medical College, Madras

How to cite this article:
Ramamurthy B, Kanaka T S. Some observation on visual function in 204 sellar lesions.Indian J Ophthalmol 1971;19:14-17

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Ramamurthy B, Kanaka T S. Some observation on visual function in 204 sellar lesions. Indian J Ophthalmol [serial online] 1971 [cited 2024 Feb 26 ];19:14-17
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With the advancement of neuro�logical sciences, the science of neuro-ophthalmology has achiev�ed great importance. This is a field in which the neurosurgeons and ophthalmologists have to co�operate 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 An�niversary Celebrations of the Go�vernment 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, institu�tion and the pioneers in ophthal�mology who have made this insti�tution 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 associa�tion of a leading ophthalmic hospital and an active neurosurgi�cal centre, the science of neuro�ophthalmology has not yet achiev�ed its rightful place. Looking back into the publications of the past decade, we would find that scientific publications on Neuro�ophthalmology 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 con�centrate 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 in�tracranial tumours; many of them came with a diagnosis of pituitary tumour because the x-rays show�ed enlarged pituitary fossa. Often this enlargement was due to an enormously dilated third ventricle caused by a lesion in the poste�rior fossa. Since those days we have progressed to highly sophi�sticated investigations like elec�troencephalography, angiography, echoencephalography and frac�tional 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 depart�ment were studied and conclu�sions drawn. This has now been brought upto-date and our experi�ence 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 in�cluded in this series. Parasellar lesions like aneurysm of the caro�tid 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, acro�megaly and in cranio pharyngio�mas shows the different ways in which these various lesions affected the visual pathway. Of the 103 cases of chromophobe adeno�mas 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 neuro�surgical department for definitive treatment.

It is also clear from the table that classical bitemporal hemia�nopia 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 appreciat�ed 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 ante�riorly and laterally only, the tumour may press on one optic nerve alone. Extending posterior�ly the tumour may cause hemiano�pia 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 diffe�rent types of field defects.

The next 3 tables show the oph�thalmoscopic findings in the 3 different varieties of tumours.

Commonly either pallor or optic atrophy was seen in adenomas of the pituitary gland. Five chromo�phobe adenomas presented with the uncommon findings of bila�teral papilloedema, while five pre�sented with a Foster Kennedy syndrome.

In acromegaly 12 out of 27 patients presented with the nor�mal fundus appearance. This may happen even when the x-ray of the skull shows the enlargement of the sella and the typical ap�pearance of acromegaly.

In cranio pharyngiomas 14 patients had bilateral papilloe�dema 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 diffi�culty went to the oculist instead of a doctor. Even in some in�stances, 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 ophthal�mologists, despite all the excess load of work will find enough time to devote to Neuro Ophthalmo�logical problems.