Clinical Assessment of Lesions Compressing the Visual Pathway

Abstract

There is a close relationship between the visual pathway and other neuro endocrine structures. Tumours and other compressive lesions could often present with visual impairment and/or finite visual field changes. Careful clinical assessment could aid in accurate diagnosis and treatment. Pituitary gland lies in the fossa located in the sphenoid bone. Growth hormone, adreno cortico tropic hormone, and prolactin secreting adenomas could present with respective endocrine features. Optic chiasmal compression by pituitary adenoma is an indicator of suprasellar extension. Meningioma and vestigial remnant craniopharyngioma arise in the parasellar region and can compress on different parts of the optic chiasma often giving rise to classical radiological appearances and visual field changes. This includes atheroma and aneurysm of the internal carotid artery impinging on the temporal chiasma exerting direct pressure and counterpressure on the contralateral side. Others are aneurysms of the precommunicating section of the anterior cerebral artery and those of the posterior communicating artery. Compressive lesions of the visual pathway require a multidisciplinary approach involving neurosurgeon, endocrinologist as well as the ophthalmologist.