Non-compressive disorders of the chiasm

Symptomatic Primary Tethered Optic Chiasm: Technical Case Report

BACKGROUND AND IMPORTANCE

Symptomatic tethering of the optic nerves and chiasm is a rare occurrence and has been reported following both surgical and medical treatment of pituitary adenoma. Here we present a case of primary optic chiasm tethering in a patient with empty sella syndrome.

CLINICAL PRESENTATION

The patient was a 61-yr-old female who presented with progressively worsening bitemporal hemianopsia. Magnetic resonance imaging (MRI) brain revealed an empty sella with herniation of the optic chiasm into the sella. The patient underwent an endoscopic, endonasal/trans-sphenoidal approach to the sella, where the optic chiasm was then detethered via lysis of arachnoid adhesions and ultimately buttressed with an abdominal fat graft. Postoperatively, the patient did well with subjective and objective improvements in her visual fields.

CONCLUSION

We report a rare case of primary tethered optic chiasm, which was successfully treated via an endoscopic, endonasal approach with abdominal fat graft harvest.

Neuro-Ophthalmology Annual Review

PURPOSE

The purpose of this review was to update the practicing ophthalmologist on the English language neuro-ophthalmology literature from the past year.

DESIGN

A review of English language literature from August 1, 2013, to August 1, 2014, was conducted.

METHODS

The author searched PubMed from August 1, 2013, to August 1, 2014, limited to English language publications including original articles, review articles, and case reports and excluding letters to the editor, unpublished work, and abstracts. The following topics were searched: pupillary abnormalities, eye movement dysfunction, neuromuscular diseases, optic neuropathies, optic neuritis, demyelinating diseases including multiple sclerosis, lesions of the optic chiasm and posterior primary visual pathways, elevated intracranial pressure, tumors and aneurysms affecting the visual pathways, vascular diseases, higher visual function, and neuroimaging advances. The focus of this review is on clinically relevant literature in the past year for the practicing ophthalmologist. The aim was to highlight remarkable and interesting literature rather than exhaustively including all new neuro-ophthalmological publications of the year.

RESULTS

Initially, more than 11,000 articles were identified. One hundred were selected that met criteria specified above.

CONCLUSIONS

This review updates the comprehensive ophthalmologist on neuro-ophthalmic topics.