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Case Report

RMJ. 2017; 42(1): 140-142

Prolapse optic nerve in empty sella with delayed visual deterioration post-endoscopic pituitary surgery: A rare case

Ruth Ng, Farah Dayana Zahedi, Salina Husain, Syazarina Sharis Osman, Jegan Thanabalan, Ramesh Kumar, Balwant Singh Gendeh.


We report a rare case of right optic nerve prolapse after endoscopic transsphenoidal surgery for a non functional pituitary macroadenoma. We believe this is the first reported case of isolated optic nerve prolapse without chiasma involvement with empty sella in the English literature. This 31-year-old male initially presented with progressively worsening right blurring of vision without hormonal disturbance. Post operatively, vision improved tremendously and continued to improve over 6 months of follow up. Nasoendoscopic examination than revealed a pulsating mass occupying the sphenoid sinus cavity. MRI of paranasal sinuses and base of skull showed a right optic nerve prolapsing into the empty sella. The patient was managed conservatively over more than 6 months and eventually the vision improved to the pre-operative state without requiring surgical intervention.

Key words: Optic nerve prolapse, pituitary adenoma, visual deterioration.

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