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Table of Contents    
Year : 2021  |  Volume : 69  |  Issue : 2  |  Page : 532-533

Giant Pituitary Adenoma Causing a Split in Optic Chiasm

1 Department of Neurosurgery and Gamma-Knife, All India Institute of Medical Sciences, New Delhi, India
2 Department of Pathology, All India Institute of Medical Sciences, New Delhi, India

Date of Submission30-Sep-2020
Date of Decision13-Dec-2020
Date of Acceptance17-Jan-2021
Date of Web Publication24-Apr-2021

Correspondence Address:
Dr. Manmohan Singh
Department of Neurosurgery and Gamma-Knife, All India Institute of Medical Sciences, New Delhi - 110 029
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/0028-3886.314530

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How to cite this article:
S Rai HI, Singh M, Singh PK, Nambirajan A, Sharma A, Jain A. Giant Pituitary Adenoma Causing a Split in Optic Chiasm. Neurol India 2021;69:532-3

How to cite this URL:
S Rai HI, Singh M, Singh PK, Nambirajan A, Sharma A, Jain A. Giant Pituitary Adenoma Causing a Split in Optic Chiasm. Neurol India [serial online] 2021 [cited 2021 Sep 17];69:532-3. Available from:

Giant pituitary adenomas are generally nonfunctional adenomas defined commonly by the presence of the largest dimension of ≥4 cm in any axis.[1] These tumors are known to compress and displace the optic pathways; however, splitting of optic pathways is a rarest phenomenon. Only four cases have been reported till date.[2],[3],[4] We report a similar case of splitting of optic chiasm by a giant non-functional pituitary adenoma.

  Case Top

A 45-year-old man presented with a history of gradually progressive visual loss of 4-year duration with temporal field defects. His hormone profile was suggestive of hypopituitarism. After hormonal normalization, he was operated through a trans-sphenoidal route at a private hospital. Histology was suggestive of pituitary adenoma. Follow up contrast MRI head revealed a large residual tumor in the sella & suprasellar region extending up to Foramen of Monro [Figure 1]. At presentation to our hospital, patient had persistent visual symptoms and his visual acuity was 6/24 in right & 2/60 in left eye [Figure 3]. He was re-operated via left pterional approach. Inter-optic, optico-carotid and trans-lamina terminalis corridors were utilized for tumor excision. Gross total tumor excision was achieved. An interesting intra-operative finding of split optic chiasm on right side by the tumor was observed [Figure 2]. The defect seen here in the chiasm has smooth margins indicating that it is not an iatrogenic defect (which shall be having irregular margins). The patient had visual decline (PL+) in his left eye postoperatively as left optic nerve was adherent to the tumor. Rest of the post-operative period was uneventful.
Figure 1: Contrast MRI brain showing a T2 hyperintense (a and b) enhancing (c-e) giant residual tumor in sella, parasellar (right Knosp 3) and suprasellar region extending into 3rd ventricle reaching the foramen of monro. (f) Post-operative contrast MRI head showing near total excision with very small residual in right side of sella

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Figure 2: Intra-operative image showing tumor splitting the optic chiasm on right side (yellow arrow). [Rt Op N- right optic nerve, Lt Op N- left optic nerve, ACA- anterior cerebral artery]

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Figure 3: Postoperative visual field charting of right eye

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Histology revealed features of a gonadotroph pituitary adenoma. The MIB 1 proliferative index was approximately 2–3% in the highest labeling areas.

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Conflicts of interest

There are no conflicts of interest.

  References Top

Iglesias P, Rodríguez Berrocal V, Díez JJ. Giant pituitary adenoma: Histological types, clinical features and therapeutic approaches. Endocrine 2018;61:407-21.  Back to cited text no. 1
Kunieda K, Nishimura Y, Kondo H, Shikinami A, Funakoshi T, Tanabe Y, et al. Scotomatous defects in the central visual field, associated with pituitary tumor. A case report. Brain and Nerve 1982;34:275-9.  Back to cited text no. 2
Hanalioğlu Ş, Işıkay İ, Berker M. Splitting of the optic nerve by a pituitary macroadenoma. World Neurosurg 2016;89:726.e11-14.  Back to cited text no. 3
Gagliardi F, Boari N, Losa M, Mortini P. Longitudinal splitting of optic pathways by non-functioning pituitary macroadenoma: Report of two cases. Acta Neurochir (Wien) 2010;152:1065-8.  Back to cited text no. 4


  [Figure 1], [Figure 2], [Figure 3]


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