Cyclic compression of the intracranial optic nerve: patterns of visual failure and recovery

A patient with a cystic craniopharyngioma below the right optic nerve had several recurrences requiring surgery. Finally the cyst was connected with a subcutaneous reservoir by means of a fine catheter. Symptoms of optic nerve compression recurred more than 50 times during the following year, and were relieved within seconds upon drainage of the reservoir. In each cycle, a drop in visual acuity preceded a measurable change in the visual field. The pattern of field changes was an increasingly severe, uniform depression. Optic nerve ischaemia induced by compression was probably the most important factor causing visual failure in this case.