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Chiasmal Compression – Post-Surgical Visual Recovery — SCE Neurology MCQ

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ModerateNeuro-ophthalmologyChiasmal Compression – Post-Surgical Visual RecoverySCE Neurology

A 55-year-old man with progressive bilateral visual loss and optic atrophy is found to have a large pituitary macroadenoma compressing the optic chiasm. His visual fields show a bitemporal hemianopia. After transphenoidal surgery, what is the expected pattern of visual field recovery?

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Correct answer: D — Temporal visual fields typically improve first as chiasmal decompression relieves crossing nasal retinal fibres — recovery can continue for up to 12 months but is not guaranteed

Following surgical decompression of the optic chiasm, visual field recovery is variable but can be significant, particularly if the compression was of relatively short duration and the optic discs are not severely atrophic. The temporal fields (subserved by the crossing nasal retinal fibres which were compressed in the chiasm) typically improve first. Recovery can continue for up to 12 months post-surgery. Severe optic atrophy at the time of surgery predicts poorer visual recovery. A: Recovery occurs in the majority of patients. C: Temporal fields improve (the previously compressed fibres). D: Recovery is gradual, not immediate. E: Visual field typically improves, not worsens.

Reference: NICE NG99 Brain Tumours; ABN Neuro-ophthalmology Guidelines