Tuberculum sellae meningiomas frequently produce visual loss by direct compression from tumor, constriction of the optic nerve (ON) under the falciform ligament, and/or ON ischemia.
Gradual loss of vision is the most common initial complaint by optic nerve compression 1) 2) 3) 4) 5) , and it has been reported that vascular elements may play a significant role in the mechanism of compression 6) 7) 8) Levatin 9) was a pioneer in 1961 when he described strangulation of the optic tract by the anterior cerebral artery in a patient harboring a suprasellar tumor. 10).
Renewed visual deterioration after some initial recovery is highly indicative of tumor recurrence 11).
In case of pressure on the chiasm, bitemporal filed defects may occur, while in prechiasmal involvement, vision in one eye may be more seriously involved than the other.