Chiasmatic syndrome caused by Rathke's cleft cyst: A case report

A case report of a 70-year-old woman who had never suffered from any eye disease is presented. It was found that 2 weeks prior to the ophthalmological examination at another clinic 'something fell' into her right eye; she noticed a decline in the vision of her the left eye. On ophthalmologic examination Visual Acuity, Right Eye (VARE) was 0.4 and Visual Acuity, Left Eye (VALE): fingers at 1 m. Incipient cataracts in both eyes, more on the right. On optic nerve (ON) evaluation, the optic papilla cup-to-disk ratio (C/D) was=0.6 and 0.7, R/L, respectively. A total of 1 month after the first examination VARE was found: 0.4 and VALE: 0.16. The cataracts did not correspond to the decrease in visual acuity. an excavation on the right papilla (C/D=0.6) was found and the left papilla was atrophic (C/D=0.7). Otherwise, the fundus evaluation was normal. Incomplete upper temporal quadrantanopia on the right visual field (VF) and temporal hemianopia extending into the central part on the left VF were identified. An electrophysiological examination (pattern visual evoked responses) showed a marked decrease in amplitudes on the right and no prolongation of P100 latency; a non-excitable reaction was observed in the left. Our finding was chiasmatic syndrome with more significant impairment on the left side. Subsequent magnetic resonance imaging (MRI) was suspicious for Rathke's cleft cyst (RCC). A neurosurgical intervention was performed the week following MRI . Using a subfrontal approach via a small right frontal craniotomy, the tumor was released from surrounding neural structures and radically removed using microsurgical techniques. During the procedure, it was not completely clear whether it was RCC or a craniopharyngioma; the biopsy findings were consistent with RCC with xanthogranulomatous changes. The authors emphasize the importance of visual field examination in unclear visual disorders, as well as the importance of follow-up examinations to uncover recurrences.