Visual Pathway 1432 Chiasmal Lesions

Anatomy: The optic chiasm and the optic nerves (Fig. 14.4) lie on the diaphragma sellae, a dural fold that forms the roof of the sella turcica.

The pituitary gland in the sella turcica lies inferior to the chiasm. The internal carotid artery defines the lateral border of the chiasm. The hypothalamus and anterior lobe of the cerebrum are located superior to the chiasm. Within the chiasm, the inferior nasal fibers cross inferiorly and anteriorly, and are therefore most likely to be affected by pituitary tumors. The superior nasal fibers cross posteriorly and superiorly within the chiasm and are therefore most likely to be affected by craniopharyngiomas. The macular fibers cross in various locations throughout the chiasm, including posteriorly and superiorly.

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