Compressive optic neuropathy in the setting of tumors of the chiasmal and sellar region: a review




compressive optic neuropathy, optic nerve/chiasm complex, optic atrophy, tumors of the chiasmal and sellar region


This is a review on compressive optic neuropathy (CON) in the setting of tumors of the chiasmal and sellar region. CON is a difficult to manage neuro-ophthalmological condition that occurs when the optic nerve is damaged due to compression of the anterior visual pathway, commonly by scull-base tumors of the middle and anterior fossae. Compression of the optic nerve/chiasm complex is accompanied by reduced vision, visual field defects and descending optic atrophy, which, if not treated properly, can lead to permanent vision loss and blindness. The literature data on the prevalence and features of visual disturbances in chiasmal-sellar tumors which differ in histology have been reviewed.


Schiefer U, Hart W. Neuro-ophthalmic presentations of orbital disease. Clinical Neuro-Ophthalmology: A Practical Guide. Wien & New York:Springer; 2007. 310 p.

Masaya-anon P, Lorpattanakasem J. Intracranial tumours affecting the visual system: 5 year review in Prasat neurological Instititute. J Med Assoc Thai. 2008;91(4):515-9. PMID: 18556861.

Onakpoya OH,Komolafe EO, Akintomide F, Ajite K, Komolafe MA, Adeolu AA, Olateju SO, Adeoye AO, Adegbehingbe B.Ophthalmic manifestations in patients with intracranial tumours. Afr J Neurol Sci. 2009;28(1):55-60.

Kitthisak K, Ployprasith C. Ocular Manifestations of Suprasellar Tumours. J Med Assoc Thai. 2008;91 (5):711-5. PMID: 18672637.

Marco S, Karimurio J, Kariuki M, Lubanga P. Visual loss and оcular involvement in adult patients with intracranial neoplasms in Kenyatta National Hospital, Nairobi, Kenya. East Afr J of Ophthalmol. 2007;13(1):15-20.

Kennedy HB, Smith RJ. Eye signs in craniopharyngioma. Br J Ophthalmol. 1975;59(12):689-95.

Kerr RG, Tobler WD, Leach JL, et al. Anatomic variation of the optic strut: classification schema, radiologic evaluation, and surgical relevance. J Neurol Surg B Skull Base. 2012;73(6):424-9.

Guthikonda B, Tobler WD Jr, Froelich SC, et al. Anatomic study of the prechiasmatic sulcus and its surgical implications. Clin Anat. 2010;23(6):622-8.

Rhoton AL Jr. The sellar region. Neurosurgery. 2002;51(4 Suppl):S335-74. PMID: 12234453.

Csillag A. The organ of vision. In: Atlas of the Sensory Organs : Functional and Clinical Anatomy. Humana Press, Totowa, N.J; 2003. pp. 85-164.

Foroozan R. Chiasmal syndromes. Curr Opin Ophthalmol 2003;14(6):325-31.

Tron EG. Diseases of the visual pathway. Мoscow: Меdgiz; 1955. 394 p. Russian.

Zander R. Über die Lage und die Dimensionen des Chiasma opticum und ihre Bedeutung für die Diagnose der Hypophysentumoren. Dtsch med Wschr Vereinbeil; 1897. 485 p.

Griessenauer CJ, Raborn J, Mortazavi MM, Tubbs RS, Cohen-Gadol AA. Relationship between the pituitary stalk angle in prefixed, normal, and postfixed optic chiasmata: an anatomic study with microsurgical application. Acta Neurochir (Wien). 2014;156:147-151.

Ba B, Diakité S, Kanté A, Touré T, Koné M, Ongoïba N, Koumaré A, Sidibé S. Anatomical Study of MRI Optic Chiasm at the Bamako Anatomy Laboratory. Forensic Medicine and Anatomy Research.2020;8:11-17.

Mncube SS, Goodier MD. Normal measurements of the optic nerve, optic nerve sheath and optic chiasm in the adult population. SA J Radiol. 2019;23(1):1772.

Wagner AL, Murtagh FR, Hazlett KS, Arrington JA. Measurement of the normal optic chiasm on coronal MR images. AJNR Am J Neuroradiol. 1997 Apr;18(4):723-6.PMID: 9127037 PMCID: PMC8338490.

Polat SО, Оksuzler FY, Oksuzler M, Uygur AG, Yucel AH. The determination of the pituitary gland, optic chiasm, and intercavernous distance measurements in healthy subjects according to age and gender. Folia Morphol (Warsz). 2020;79(1):28-35

Juenger V, Cooper G, Chien C, Chikermane M, Oertel FC, Zimmermann H, Ruprecht K, Jarius S, Siebert N, Kuchling J, Papadopoulou A, Asseyer S, Bellmann-Strobl J, Paul F, Brandt AU, Scheel M. Optic chiasm measurements may be useful markers of anterior optic pathway degeneration in neuromyelitis optica spectrum disorders. Eur Radiol. 2020 Sep;30(9):5048-5058.

Parravano JG, Toledo A, Kucharczyk W. Dimensions of the optic nerves, chiasm, and tracts: MR quantitative comparison between patients with optic atrophy and normals. J Comput Assist Tomogr. 1993 Sep-Oct;17(5):688-90.

Schiefer U, Isbert M, Mikolaschek E, Mildenberger I, Krapp E, Schiller J, Thanos S, Hart W. Distribution of scotoma pattern related to chiasmal lesions with special reference to anterior junction syndrome. Graefes Arch Clin Exp Ophthalmol. 2004;242(6):468-77.

Miller NR, Newman NJ, Biousse V, Kerrison JB. Walsh & Hoyt's Clinical Neuro-Ophthalmology, sixth ed. Lippincott Williams & Wilkins, Philadelphia; 2005. 320 p.

Renn WH, Rhoton AL Jr: Microsurgical anatomy of the sellar region. J Neurosurg. 1975;43:288-298.

Bergland RM, Ray BS, Torack M. Anatomical variations in the pituitary gland and adjacent structures in 225 human autopsy cases. J Neurosurg. 1968;28:93-99.

Bergland R, Ray BS. The arterial supply of the human optic chiasm. J Neurosurg. 1969;31:327-334.

Gibo H, Lenkey C, Rhoton AL. Microsurgical anatomy of the supraclinoid portion of the internal carotid artery. J Neurosurg. 1981 Oct;55(4):560-74.

Danesh-Meyer HV, Yoon JJ, Lawlor M, Savino PJ. Visual loss and recovery in chiasmal compression. Prog Retin Eye Res. 2019 Nov;73:100765.

Henschen S. Revue Critique De La Doctrine Sur Le Centre Cortical De La Vision. In: XIII Congres International de Medicine Section D'Ophthalmologie. Paris, France: 1900.

Hoyt WF. Correlative functional anatomy of the optic chiasm. Neurosurgery. 1970;17:189-208.

Vit VV. The structure of the human visual system. Odessa: Astroprint; 2003. 664 p. ISBN 966-318-012-9.

Shane Tubbs R, Rizk E, Shoja MM, Loukas M, Barbaro N, Spinner R. Nerves and Nerve Injuries: Vol 1: History, Embryology, Anatomy, Imaging, and Diagnostics. Academic Press; 2015. 700 p.

Mai JK, Paxinos G. The Human Nervous System. 3rd. London : Elsiever Inc; 2011. 432 p.

Willson-Pawells L, Akesson EJ, Stewart PA. Cranial Nerves in Health and Disease. 3rd. London : PMPH-USA; 2010. 247 p.

Ireland AC, Iverson B. Neuroanatomy, Optic Chiasm. Carter: Treasure Island (FL): StatPearls Publishing; 2023.

Kupfer C, Chumbley L, Downer JC. Quantitative histology of optic nerve, optic tract and lateral geniculate nucleus of man. J Anat. 1967; 101:393-401. PMID: 6051727 PMCID: PMC1270921.

Chacko LW. The laminar pattern of the lateral geniculate body in the primates. J Neurol Neurosurg Psychiatry.1948; 11: 211-224.

Wilbrand H, Saenger A. Die Neurologie des Auges. Wiesbaden JBergmann. 1904;98 - 120.

Hoyt WF, Luis O. The primate chiasm. Details of visual fiber organization studied by silver impregnation techniques. Arch Ophthalmol. 1963;70:69-85.

Horton JH.Wilbrand's Knee: To Be or Not to Be a Knee?J Neuroophthalmol. 2020; 40 (1):S7-S14.

Lee JH, Tobias S, Kwon J, Sade B, Kosmorsky G. Wilbrand's knee: does it exist?Surg Neurol. 2006 Jul;66(1):11-7.

Grzybowski A, Kanclerz P. The Wilbrand's knee does not exist in the optic chiasm. Childs Nerv Syst. 2018;34(11):2133.

Freda PU, Post KD. Differential diagnosis of sellar masses. Endocrinol Metab Clin North Am 1999;28(1):81-117.

Bresson D, Herman P, Polivka M, Froelich S. Sellar Lesions/Pathology. Otolaryngol Clin North Am. 2016; 49(1):63-93.

Wang EW, Zanation AM, Gardner PA, Schwartz TH, Eloy JA, et al. ICAR: endoscopic skull-base surgery. Int. Forum Allergy Rhinol. 2019 Jul;9(S3): S145-S365.

Ammirati MZH. Oncology. In: Brem H, editor. Youmansneurological surgery, vol. 2. Philadelphia: Elsevier Saunders;2011.1025 p.

Abouaf L, Vighetto A, Lebas M. Neuro-ophthalmologic exploration in non-functioning pituitary adenoma. Annals of Endocrinology. 2015;76(3):210-9.

Lee DK, Sung MS, Park SW. Factors Influencing Visual Field Recovery after Transsphenoidal Resection of a Pituitary Adenoma. Korean J Ophthalmol. 2018;32(6): 488-96.

Scheithauer BW. Surgical pathology of the pituitary: The adenomas. Part I. Pathol Annu. 1984;19:317-374.

Ezzat S, Asa SL, Couldwell WT, Barr CE, Dodge WE, Vance ML, McCutcheon IE. The prevalence of pituitary adenomas: a systematic review. Cancer. 2004;101(3):613-9.

Daly AF, Beckers A. The Epidemiology of Pituitary Adenomas. Endocrinol Metab Clin North Am. 2020 Sep;49(3):347-355.

Mete O, Cintosun A, Pressman I, Asa SL. Epidemiology and biomarker profile of pituitary adenohypophysial tumors. Mod Pathol. 2018 Jun;31(6):900-909.

Guk MO. Diagnosis and comprehensive treatment of hormonally-inactive pituitary adenomas. Thesis for Doctor of Medical Sciences. Kyiv. 2017.

Kitthaweesin K, Ployprasith C. Ocular manifestations of suprasellar tumors. J Med Assoc Thai. 2008; 91(5):711-5.

Ntali G, Wass JA. Epidemiology, clinical presentation and diagnosis of non-functioning pituitary adenomas. Pituitary. 2018; 21(2):111-8.

Yasargil MG. Microsurgery Applied to Neurosurgery. Stuttgart: Thieme, 1969.

Knosp E, Steiner E, Kitz K, Matula C. Pituitary adenomas with invasion of the cavernous sinus space: a magnetic resonance imaging classification compared with surgical findings. Neurosurgery. 1993; 33(4):610-7; discussion 617-8.

Kovacs K, Horvath E, Vidal S. Classification of pituitary adenomas. J Neurooncol.2001;54(2):121-7.

Mohr G, Hardy J, Comtois R, Beauregard H. Surgical management of giant pituitary adenomas. Can J Neurol Sci. 1990;17(1):62-6.

Mortini P, Barzaghi R, Losa M, et al. Surgical treatment of giant pituitary adenomas: strategies and results in a series of 95 consecutive patients. Neurosurgery. 2007; 60(6):993-1002.

Goel A, Nadkarni T, Muzumdar D, Desai K, Phalke U, Sharma P. Giant pituitary tumors: a study based on surgical treatment of 118 cases. Surg Neurol. 2004 May;61(5):436-45; discussion 445-6.

Shrivastava RK, Arginteanu MS, King WA, Post KD. Giant prolactinomas: Clinical management and long-term follow up. J Neurosurg. 2002; 97:299-306.

Simon S, Torpy D, Brophy B, Blumbergs P, Selva D, Crompton JL. Neuro-ophthalmic manifestations and outcomes of pituitary apoplexy - a life and sight-threatening emergency. NZ Med J. 2011; 124(1335):52-9.PMID: 21946682.

Biousse V, Newman NJ, Oyesiku NM. Precipitating factors in pituitary apoplexy. J Neurol Neurosurg Psychiatry. 2001; 71(4): 542-545.

Randeva HS, Schoebel J, Byrne J, Esiri M, Adams CB, Wass JA. Classical pituitary apoplexy: clinical features, management and outcome. Clin Endocrinol (Oxf). 1999;51(2):181-8.

Turgut M, Ozsunar Y, Basak S, Guney E, Kir E, Meteoglu I. Pituitary apoplexy: an overview of 186 cases published during the last century. Acta Neurochir (Wien). 2010; 152(5): 749-61.

Wakai S, Fukushima T, Teramoto A, Sano K. Pituitary apoplexy: its incidence and clinical significance. J Neurosurg. 1981;55(2):187-93.

Dubuisson AS, Beckers A, Stevenaert A. Classical pituitary tumour apoplexy: clinical features, management and outcomes in a series of 24 patients. Clin Neurol Neurosurg. 2007;109(1):63-70.

BonickiW, Kasperlik-ZałuskaA, KoszewskiW, ZgliczyńskiW, WisławskiJ. Pituitaryapoplexy: endocrine, surgicalandoncologicalemergency. Incidence, clinicalcourse and treatment with reference to 799 cases of pituitary adenomas. Acta Neurochir (Wien). 1993;120(3-4):118-22.

Chuang CC, Chang CN, Wei KC, Liao CC, Hsu PW, Huang YC, et al. Surgical treatment for severe visual compromised patients after pituitary apoplexy. J Neurooncol. 2006;80(1):39-47.

Bi WL, Dunn IF, Laws ER Jr. Pituitary apoplexy. Endocrine. 2015, 48(1):69-75.

Ayuk J, McGregor EJ, Mitchell RD, Gittoes NJ. Acute management of pituitary apoplexy - surgery of conservative management? Clin Endocrinol (Oxf). 2004 Dec;61(6):747-52.

Cavallo LM, Frank G, Cappabianca P, Solari D, Mazzatenta D, Villa Zoli AM, D'Enza AI, Esposito F, Pasquini E. The endoscopic endonasal approach for the management of craniopharyngiomas: a series of 103 patients. J Neurosurg. 2014;121(1):100-13.

Kassam AB, Prevedello DM, Carrau RL, Snyderman CH, Thomas A, Gardner P, et al. Endoscopic endonasal skull base surgery: analysis of complications in the authors' initial 800 patients. J Neurosurg. 2011;114(6):1544-68.

Louis DN, Ohgaki H, Wiestler OD, Webster K C, Burger PC, Jouvet A, et al. The 2007 WHO classification of tumours of the central nervous system. Acta Neuropathol. 2007;114(2):97-109.

Mortini P, Gagliardi F, Boari N, Losa M. Surgical strategies and modern therapeutic options in the treatment of craniopharyngiomas Crit Rev Oncol Hematol. 2013 Dec;88(3):514-29.

Karavitaki N, Brufani C, Warner J T, Adams C, Richards P, Ansorge O, Shine B, Turner H, Wass J. Craniopharyngiomas in children and adults: systematic analysis of 121 cases with long-term follow-up. Clin. Endocrinol (Oxf). 2005 Apr;62(4):397-409.

Amirjamshidi A, Mortazavi SA, Shirani M, Saeedinia S, Hanif H. 'Coexisting pituitary adenoma and suprasellar meningioma-a coincidence or causation effect: report of two cases and review of the literature'. J Surg Case Rep. 2017 May; 22(5):rjx039.

Valassi E, Biller BM, Klibanski A, Swearingen B. Clinical features of nonpituitary sellar lesions in a large surgical series. Clin Endocrinol (Oxf). 2010 Dec;73(6):798-807.

Ajlan AM, Choudhri O, Hwang P, Harsh G. Meningiomas of the tuberculum and diaphragma sellae. J Neurol Surg B Skull Base. 2015 Feb;76(1):74-9.

FitzPatrick M, Tartaglino LM, Hollander MD, Zimmerman RA, Flanders AE. Imaging of sellar and parasellar pathology. Radiol Clin North Am. 1999 Jan;37(1):101-21, x.

Chi JH, McDermott MW. Tuberculum sellae meningiomas. Neurosurg Focus. 2003 Jun 15;14(6):e6.

Mariniello G, Bonavolontà G, Tranfa F, Maiuri F. Management of the optic canal invasion and visual outcome in spheno-orbital meningiomas. Clin Neurol Neurosurg. 2013 Sep;115(9):1615-20.

Galal A, Faisal A, Al-Werdany M, El Shehaby A, Lotfy T, Moharram H. Determinants of postoperative visual recovery in suprasellar meningiomas. Acta Neurochir (Wien). 2010 Jan;152(1):69-77.

Wang CW, Li YY, Zhu SG, Yang Y, Wang HW, Gong J, Liu YG. Surgical management and evaluation of prognostic factors influencing postoperative visual outcome of suprasellar meningiomas. World Neurosurg. 2011 Feb;75(2):294-302.

Perondi GE, Isolan GR, de Aguiar PH, Stefani MA, Falcetta EF. Endoscopic anatomy of sellar region. Pituitary. 2013 Jun;16(2):251-9.

Ito YA, Di Polo A. Mitochondrial dynamics, transport, and quality control: a bottleneck for retinal ganglion cell viability in optic neuropathies. Mitochondrion.2017 Sep;36:186-192.

Kanamori A, Catrinescu MM, Belisle JM, Costantino S, Levin LA. Retrograde and Wallerian axonal degeneration occur synchronously after retinal ganglion cell axotomy. Am J Pathol. 2012; 181(1): 62-73.

Wadud SA, Ahmed S, Choudhury N, Chowdhury D. Evaluation of ophthalmic manifestations in patients with intracranial tumours. Mymensingh Med J. 2014; 23(2):268-71. PMID: 24858153.

Sefi-Yurdakul N. Visual findings as primary manifestations in patients with intracranial tumors. Int J Ophthalmol. 2015; 8(4):800-3. DOI: 10.3980/j.issn.2222-3959.2015.04.28. eCollection 2015.

Carrim ZI, Reeks GA, Chohan AW, Dunn LT, Hadley DM. Predicting impairment of central vision from dimensions of the optic chiasm in patients with pituitary adenoma. Acta Neurochir (Wien). 2007; 149(3): 255-60 discussion 260.

Ebersold MJ, Quast LM, Laws Jr ER, Scheithauer B, Randall RV. Longterm results in transsphenoidal removal of nonfunctioning pituitary adenomas. J Neurosurg. 1986; 64(5): 713-9.

Ogra S, Nichols AD, Stylli S, Kaye AH, Savino PJ, Danesh-Meyer HV. Visual acuity and pattern of visual field loss at presentation in pituitary adenoma. J Clin Neurosci. 2014; 21(5): 735-40.

Barzaghi LR, Medone M, Losa M, Bianchi S, Giovanelli M, Mortini P. Prognostic factors of visual field improvement after trans-sphenoidal approach for pituitary macroadenomas: review of the literature and analysis by quantitative method. Neurosurg Rev.2012; 35(3): 369-78 discussion 378-369.

Findlay G, McFadzean R.M, Teasdale G. Recovery of vision following treatment of pituitary tumours; application of a new system of assessment to patients treated by transsphenoidal operation. Acta Neurochir (Wien).1983;68(3-4):175-86.

Gnanalingham KK, Bhattacharjee S, Pennington R, Ng J, Mendoza N. The time course of visual field recovery following transphenoidal surgery for pituitary adenomas: predictive factors for a good outcome. J Neurol Neurosurg Psychiatry.2005; 76(3):415-9.

PoonA, McNeill P, Harper A, O'Day J. Patterns of visual loss associated with pituitary macroadenomas. Aust N Z J Ophthalmol. 1995;23(2), 107-115.

Tagoe N N, Essuman V A, Fordjuor G, Akpalu G, Bankah P, Ndanu T. Neuro-ophthalmic and clinical characteristics of brain tumours in a tertiary hospital in Ghana. Ghana Med J. 2015; 49(3):181-6.

Cohen AR, Cooper PR, Kupersmith MJ, Flamm ES, Ransohoff J. Visual recovery after transsphenoidal removal of pituitary adenomas. Neurosurgery.1985; 17(3):446-52.

Schmalisch K, Milian M, Schimitzek T, Lagreze WA, HoneggerJ. Predictors for visual dysfunction in nonfunctioning pituitary adenomas - implications for neurosurgical management. Clin Endocrinol. 2012; 77(5):728-34.

Kim SH, Lee KC, Kim SH. Cranial nerve palsies accompanying pituitary tumour. J of Clinical Neurosciense. 2006; 14(12):1158-62.

Chuang CC, Chen E, Huang YC, Tu PH,Chen YL, Pai PC. Surgical outcome of oculomotor nerve palsy in pituitary adenoma. J Clin Neurosci. 2011; 18(11): 1463-8.

Hage R, Eshraghi SR, Oyesiku NM, Ioachimescu AG, Newman NJ, Biousse V, Bruce BB. Third, fourth, and sixth cranial nerve palsies in pituitary apoplexy. World Neurosurg. 2016; 94: 447-52.

Farooq K, Tayyaba Gul M, Rashid A. Pituitary macroadenomas; demographic, visual, and neuro-radiological patterns. Prof Med J. 2010; 17(4), 623-627.

Kayan A, Earl CJ. Compressive lesions of the optic nerves and chiasm: pattern of recovery of vision following surgical treatment. Brain. 1975; 98(1): 13-28.

McDonald WI. The symptomology of tumours of the anterior visual pathways. Can J Neurol Sci 1982;9(4):381-90.

Peter M, De Tribolet N. Visual outcome after transsphenoidal surgery for pituitary adenomas. Br J Neurosurg. 1995;9(2):151-157.

Zhang Y, Chen C, Huang W, Teng Y, Shu X, Zhao F, et al. Preoperative volume of the optic chiasm is an easily obtained predictor for visual recovery of pituitary adenoma patients following endoscopic endonasal transsphenoidal surgery: a cohort study. Int J Surg. 2023 Apr 1;109(4):896-904.

Ji X, Zhuang X, Yang S, Zhang K, Li X, Yuan K, et al. Visual field improvement after endoscopic transsphenoidal surgery in patients with pituitary adenoma. Front Oncol. 2023 Feb 15;13:1108883.

Zhang Y, Zheng J, Huang Z, Teng Y, Chen C, Xu J. Predicting visual recovery in pituitary adenoma patients post-endoscopic endonasal transsphenoidal surgery: Harnessing delta-radiomics of the optic chiasm from MRI. Eur Radiol. 2023 Nov;33(11):7482-7493.

Banc A, Biousse V, Newman NJ, Kedar S. Ocular Optical Coherence Tomography in the Evaluation of Sellar and Parasellar Masses: A Review. Neurosurgery. 2023 Jan 1;92(1):42-67. DOI: 10.1227/neu.0000000000002186.

Van Gerven L, Qian Z, Starovoyt A, Jorissen M, Meulemans J, van Loon J, et al. Endoscopic, Endonasal Transsphenoidal Surgery for Tumors of the Sellar and Suprasellar Region: A Monocentric Historical Cohort Study of 369 Patients. Front Oncol. 2021 May 7;11:643550.

Chen J, Liu H, Man S, Liu G, Li Q, Zuo Q, et al. Endoscopic vs. Microscopic Transsphenoidal Surgery for the Treatment of Pituitary Adenoma: A Meta-Analysis. Front Surg. 2022 Feb 2;8:806855.

Vassilyeva N, Mena N, Kirov K, Diatlova E. Comparative effectiveness of endoscopic and microscopic adenoma removal in acromegaly. Front Endocrinol (Lausanne). 2023 Sep 11;14:1128345.



How to Cite

Iegorova K. Compressive optic neuropathy in the setting of tumors of the chiasmal and sellar region: a review. J.ophthalmol. (Ukraine) [Internet]. 2023 Dec. 27 [cited 2024 Mar. 5];(6):49-58. Available from: