Anatomic review and topographic diagnosis

Neuro-ophthalmologic disorders affecting the afferent and efferent visual p athways are frequently encountered by neurosurgeons in clinical practice. S igns and symptoms of visual pathway dysfunction occur commonly as initial p resenting features of neurosurgical diseases, including intracranial tumors , aneurysms, arteriovenous malformations, carotid-cavernous fistulas, and c arotid artery atherosclerotic disease. Visual loss and ocular motility diso rders may also occur following surgery for such conditions. Prompt recognit ion and localization of neuro-ophthalmologic signs and symptoms may be cruc ial to effective diagnosis and management. This review concentrates on thos e aspects of neuroanatomy that are most important to the diagnosis of affer ent and efferent visual pathway lesions. The use of optic disc and fundus a ppearance, visual fields, and ocular motility and pupillary findings is emp hasized in the discussions on topographical diagnosis.