Bitemporal hemianopia arising from a suprasellar craniopharyngioma

Craniopharyngiomas are uncommon intracranial tumors that arise from remnants of the embryonic craniopharyngeal duct. Although benign in nature, craniopharyngiomas can contribute to significant morbidity. When located near critical structures such as the optic chiasm, pituitary, and hypothalamus, craniopharyngiomas have the potential to cause severe visual, neurological, and endocrine deficits.

A 61-year-old white man presented for an eye examination, complaining of acute peripheral visual field loss in his left eye. Automated threshold visual field testing found a bitemporal hemianopia with spared fixation in his right eye and split fixation in his left eye. Subsequent neuroimaging found a space-occupying suprasellar lesion that was producing substantial optic chiasm compression. Transsphenoidal resection was used to excise the mass. Histologic examination established the diagnosis of a craniopharyngioma. Postoperative complications included cerebrospinal rhinorrhea, hypertropia, and exotropia.

To facilitate early diagnosis and treatment, eye care professionals should be aware that craniopharyngiomas can present with decreased visual acuity and bitemporal hemianopia. Visual deficits can arise from both the aggressive nature of craniopharyngiomas as well as the therapeutic intervention. Patients treated for craniopharyngiomas are at risk for recurrence and need to be followed up on a long-term basis.