Intracranial tumors affecting visual system: 5-year review in Prasat Neurological Institute

To study the types of intracranial tumors with histological confirmation that impair visual system and to determine the neuro-ophthalmic manifestations in patients with intracranial tumors.

Retrospective review of patients with intracranial tumors who were pre-operatively examined by ophthalmologists in the neuro-ophthalmology unit, Prasat Neurological Institute. All patients had tissue pathology confirmation, and the authors excluded the patients with recurrence or post-operative status of intracranial tumors.

Male to female ratio was 1:2.5 of 149 patients. The age onset was highest in the 4th to 5th decade. The three most common types of intracranial tumors were meningioma (45%), pituitary adenoma (32.9%), tumors of neuroepithelial tissues (6.7%) and craniopharyngioma (6.7%).Common neuro-ophthalmological symptoms were visual blur (88.6%) and proptosis (12.1%). In addition, common signs were visual field defect (80.5%), abnormal optic discs (69.7%), and relatively afferent pupillary defect (43.6%). Ninety percent of the patients had the visual difficulty symptom for less than 12 months, before the diagnosis of intracranial tumors. Fifty-nine percent of the patients presented with visual acuity 20/200 or worse, and 15.4% of the patients presented with no light perception (NLP).

From the study, meningioma is the most common tumor that impairs the visual pathway structures followed by pituitary adenoma. Furthermore, decreased visual acuity, visual field defects, abnormal optic discs, and relatively afferent pupillary defect are the common neuro-ophthalmic features that should be carefully examined to avoid late detection of intracranial tumors.