Visual Field Defect Patterns and Junctional Scotoma in Sellar and Parasellar Region Tumors. Experience in a Neuro-Ophthalmology Clinic of a Tertiary Hospital
Keywords:
sellar region tumor, junctional scotoma, junctional scotoma of Traquair, visual field defectAbstract
Objective: To demonstrate the visual field defect patterns of patients with sellar and parasellar region tumors in a tertiary neuro-ophthalmology clinic.
Methods: The data of all patients in the neuro-ophthalmology clinic at Naresuan University Hospital who presented with visual loss and were diagnosed with sellar/parasellar region tumors over 4 consecutive years were retrospectively reviewed. Visual fields (VF) were tested by the Humphrey Visual Field Analyzer 24-2 or 30-2 and were categorized into 5 groups: junctional scotoma (basic), junctional scotoma of Traquair, bitemporal defect, diffused loss in only one eye, and others.
Results: Among 39 patients, the diagnosis consisted of tuberculum sellae meningioma (25.64%), pituitary macroadenoma (20.51%), sphenoid wing meningioma (15.38%), craniopharyngioma (10.26%), cavernous sinus meningioma (7.69%), planum sphenoidale meningioma (5.13%), pituitary cyst (5.13%), sellar meningioma (5.13%), Rathke cleft cyst (2.56%), and clinoid meningioma (2.56%). Junctional scotoma was found as a sign of tumors in 41.03% of patients (junctional scotoma (basic) in 33.33% and junctional scotoma of Traquair in 7.69%), followed by bitemporal defect (35.90%). By using the multivariable logistic regression models, initial best-corrected visual acuity of a worse eye at 1.00 logMAR or poorer (AOR, 12.45; 95% CI, 1.03-150.34, p = 0.047), and tuberculum sellae meningioma (AOR, 36.76; 95% CI, 2.06-656.83, p = 0.014) were independent factors associated with junctional scotoma.
Conclusions: The junctional scotomas, both the basic one and the junctional scotoma of Traquair, are valuable tools for sellar/parasellar region tumor detection, especially the tuberculum sellae meningioma. It is crucial that general ophthalmologists be able to distinguish this type of visual field defect and request the appropriate further investigations.
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