What Comes Down Must Go Up—Chiasmal Prolapse: A Field Report

Abstract

We report a case of a 45-year-old man who had experienced considerable improvement in vision following surgery to excise a non-functioning pituitary adenoma. However, 1 year after surgery, during a regular followup, secondary visual field changes were detected that prompted neuroimaging. Magnetic resonance imaging revealed an empty sella with chiasmal prolapse, with no recurrence of the tumour. The patient underwent an endoscopic endonasal transsphenoidal chiasmapexy. Post-operatively the visual fields and the visual acuity showed improvement. This case emphasises the need for monitoring of visual fields, even post-operatively in cases of pituitary tumour. Chiasmal herniation can cause secondary visual field changes, early recognition of which can help in prompt surgical intervention to reverse the field loss.