Neuro-Ophthalmologic Evaluation of Pituitary Tumors

Abstract

The intricate anatomy of the fiber pathways within the optic chiasm, nerves, and tracts manifests itself in a myriad of visual symptoms. Sir Isaac Newton (cited by Rucker) (1) first speculated about the crossing of the fiber tracts within the chiasm in 1704. Since then, through the landmark writings of Harvey Cushing (2) and Traquair (3), and to the present time, the effects of pituitary and related tumors on the visual pathway have intrigued neuro-surgeons, ophthalmologists, and neurologists. Several excellent reviews of the neuro-ophthalmologic features of the optic chiasm and pituitary tumors have been published (4–12). This chapter reviews new developments in the embryology of the optic chiasm, the nature and pathogenesis of visual symptoms in relation to relevant anatomy of the chiasm and optic nerves, visual syndromes caused by pituitary and related tumors, and the recovery of visual dysfunction following various management strategies.