Fundal examination may reveal optic atrophy, which indicates that compression is long-standing, or may show normal discs, which indicate a potentially good prognosis for vision. Optic atrophy does not necessarily indicate a poor outcome from surgery as is shown in one of the surgical series (9). The observation of an opticociliary shunt vessel provides strong evidence against a pituitary tumor as a cause of the visual loss and, in adults, suggests the presence of an optic nerve meningioma.
Papilledema is excessively rare, although may be rarely seen when a tumor extends to block the foramina of Monro. The importance of tilted discs is discussed under "Results of Surgery and Recovery of Vision" following.
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