Vascular architecture of the human optic chiasma and bitemporal hemianopia

The blood supply system of the optic chiasma was studied in 85 fresh human specimens using various histological and anatomical methods. Computer image analysis and ultrastructural examinations of the microvessel in 58 fetal specimens were also conducted. The authors found that the medial portion of the chiasma is a weak point in the microcirculation network. This weak point is apt to be disturbed first and become ischemic, causing disorders of the crossing optic nerve fibers and resulting in characteristic bitemporal visual field defects. SEM studies showed no ultrastructural difference between the capillaries at the medial and lateral portions of the chiasma. It was concluded that: 1) No special artery supplies the median chiasma the weak point of microcirculation at the median chiasma is due to its relatively scanty capillary distribution; 2) "lateral chiasma arteries" could provide a better blood supply to the lateral fibers and thus the nasal quadrantic visual field could be preserved in many late stages of visual field defect in sellar region tumors; 3) cases with pituitary microadenoma which is not sufficiently large to press the chiasma but involves bitemporal visual field defect are due to the tumor receiving "shunt-flow" (stealing blood) from the chiasma through the peri-infundibulum plexus.