Suprasellar Germinoma

    • Suprasellar tumor arising from germ cells
    • Vision loss is caused by compression
    • Teenagers are most at risk
    • No sex predominance
    • Often cured by chemotherapy and radiation therapy
    • Core clinical features
      • Subacute or chronic vision loss
      • Hemianopic visual field defects
      • Optic discs appear normal or pale
      • Afferent pupil defect
    • Possible accompanying clinical features
      • Hypopituitarism, especially diabetes insipidus
      • Dorsal midbrain syndrome from a pineal region germinoma
    • Imaging features
      • Suprasellar mass that enhances avidly
      • Pineal mass often also present
      • Tumor deposits in cauda equina sometimes present (“dropped metastases”)
    • Other masses in sellar region
    • Arachnoid cyst
    • Epidermoid cyst
    • Langerhans cell histiocytosis
    • Sphenoid sinusitis or mucocele
    • Lymphocytic hypophysitis
    • Pituitary abscess
    • Multiple sclerosis
    • Neuromyelitis optica
    • Sarcoidosis
    • Refer to a neurosurgeon
    • Spine MRI will be performed to exclude dropped metastases
    • Lumbar puncture will be performed to detect markers of nongerminomatous germ cell tumors
    • Biopsy of the lesion will be performed if imaging is not distinctive
    • Platinum-based chemotherapy is sometimes followed by low-dose brain radiation therapy
    • Permanent cure will occur in >90% with minimal or no lingering neurologic deficits
    • Visual recovery depends on how much damage has occurred before treatment began

    Optic Nerve And Chiasm Disorders

    Drusen Optic Neuropathy Colobomatous Optic Neuropathy Optic Pit Neuropathy Morning Glory Optic Neuropathy Hypoplastic Optic Neuropathy Typical Optic Neuritis Atypical Optic Neuritis Papillitis (Neuroretinitis) Non-arteritic Ischemic Optic Neuropathy Arteritic Ischemic Optic Neuropathy Posterior Ischemic Optic Neuropathy Hypotensive Ischemic Optic Neuropathy Radiation-induced Optic Neuropathy Diabetic Papillopathy Hypertensive Optic Disc Edema Papilledema Idiopathic Intracranial Hypertension (Pseudotumor Cerebri) Compressive Optic Neuropathy: Overview Optic Neuropathy of Graves Disease Optic Nerve Sheath Meningioma Sphenoid Meningioma Craniopharyngioma Pituitary Adenoma Pilocytic Astrocytoma (Optic Glioma) Carotid Aneurysm Suprasellar Germinoma Infiltrative (Neoplastic) Optic Neuropathy Paraneoplastic Optic Neuropathy Traumatic Optic Neuropathy Toxic Optic Neuropathy Nutritional Deficiency Optic Neuropathy Dominantly-Inherited Optic Neuropathy Leber Hereditary Optic Neuropathy Primary Open Angle Glaucoma