Compare Visual Dysfunction in Adult Patients Who Lost Vision from Pituitary Tumor and Spheno-Orbital Meningioma

Purpose: Visual loss is a common comorbidity and could be the sole presenting symptom in patients with skull base mass owing to compression of the anterior visual pathway. In this study, we seek to characterize the visual dysfunction at the presentation of pituitary tumor and spheno-orbital meningioma, the two most common skull base tumors that cause visual loss.

Methods: The research was approved by the University of Wisconsin Madison Internal Review Board (IRB). Retrospective chart review was conducted on adult patients with pituitary tumor and spheno-orbital meningioma who presented to the University of Wisconsin Neurosurgery Clinic from 2006 to 2013. Patients’ demographics, history of visual loss, and visual function at presentation were collected. Visual function examination included Snellen Visual Acuity, Ishihara color plate, and visual field mean deviation (MD) using static threshold perimetry (Allergan-Humphrey, Inc, San Leandro, California). Descriptive statistics were used to compare the characteristics of the visual loss between pituitary tumor and spheno-orbital meningioma.

Results: Detailed visual assessments were available in 79 of 201 patients with pituitary tumor and 38 of 81 patients with spheno-orbital meningioma. Pituitary adenoma constituted ninety percent of the pituitary tumor. Patients with pituitary tumor presented at a younger age than those with spheno-orbital meningioma (mean age: 48.62 vs. 54.94 years). Spheno-orbital meningioma showed female preponderance compared with the pituitary tumor (female to male ratio: 2.59 vs. 0.93). Patients with pituitary tumor demonstrated a relatively preserved visual acuity (median: 20/20) but significant visual field loss (MD mean ± SD: −5.37 ± 5.64 dB), whereas patients with spheno-orbital meningioma had worse visual acuity (median: 20/25) and significant visual field loss (MD mean ± SD: 8.91 ± 11.04 dB). The subjective visual loss was reported in 10% of the pituitary tumor and 35% of spheno-orbital meningioma patients.

Conclusion: Compared with spheno-orbital meningioma, patients with pituitary tumor are less likely to report a subjective visual loss. The younger age at the presentation of pituitary tumor is likely attributed to systemic symptoms resulted from endocrinologic dysfunction. Detailed visual assessment should be incorporated in the management of skull base tumor.