Ocular symptoms of tumors at sella turcica region.

Background: The sella tumors were found in 15% of intracranial tumors. The sella turcica region locates in the base of skull, so the carcinoma patients in early stage often showed no intracranial hypertension and other positive signs of neural system. However, the patients presented visual field defect and hypopsia, and often went to see the doctor of ophthalmology, which resulted from that the tumor often compressed optic nerve and chiasm. We analysed the symptomatic changes of the visual organs in order to provide a diagnostic basis for sellar tumor in ophthalmological department.

Methods: Of the 407 cases of sellar tumors, 296 were pituitary adenoma, 52 were craniopharyngioma, 43 were meningioma, and the rest 16 were other kinds of sellar tumors. We analysed their ocular changes of the sellar tumors and the characteristics of the tumors.

Results: The sellar tumor in its early stage is mainly symptomized as visual field changes. Visual field defect was found in 92.9% of pituitary adnoma, 75% of craniopharyngioma and 34.8% meningioma patients. The patients of intermediate and later sellar tumors gradually manifested the hypopsia and optic atrophy. Hypopsia was found in 86.5% of pituitary adenoma patients, 89.9% of craniopharyngioma and 48.8% of meningioma patients. The morbidity rate of optic atrophy is 59.5% in patients with pituitary adenoma, 65.5% of craniopharyngioma and 44.1% of meningioma.

Conclusions: The misdiagnostic rate of sellar tumor in ophthalmological department still keeps comparatively high. The reason is that: (1) The doctors lack the neuroophthalmological knowledge. (2) The patients were not examined attentively enough. The ocular symptoms of sellar tumors are often the first occurred and most important changes. In the clinical practice, all the patients showing visual acuity and visual field disturbances should be examined carefully (especially in visual field) and excluded ocular diseases, should be transferred to the department of neurosurgery for further diagnosis and treatment.