Be alert to the effects of saddle tumors on vision Tumors in the saddle area are common not only in neurosurgery but also in ophthalmology. However, because the saddle is located at the base of the skull and far from the brain and ventricular system, tumors in this area rarely produce elevated intracranial pressure and positive neurological signs, but mostly manifest as vision loss, visual field damage and fundus changes due to pressure on the optic cross and optic nerve, so patients often consult the ophthalmology department first. The main clinical manifestations of saddle area tumor include the following aspects: (1) Visual acuity loss The tumor develops into the saddle area and compresses the optic cross nerve, fibers and capillaries, causing optic nerve dysfunction, visual acuity loss, visual field damage and fundus changes. Therefore, patients are often first seen in the ophthalmology department, and vision loss varies in speed, but mostly in both eyes. Early and timely treatment can restore visual acuity, while treatment only when there are significant fundus changes is difficult for most patients to recover. Therefore, saddle area tumors should be considered for any bilateral and monocular vision loss with unexplained visual field defects, otherwise they are easily misdiagnosed. (2) Visual field damage The arrangement of nerves and fibers in the cross-eye area is complex and regular, so the visual field examination is important for the localization and qualitative diagnosis of saddle area tumor. (3) Fundus changes The fundus shows optic papillary edema or optic nerve atrophy. The color of the optic papilla can become pale only after several months of vision loss. The degree of optic nerve atrophy is related to the severity and time of pressure on the optic cross and optic nerve, and generally develops proportionally to the degree of vision loss, the fundus shows pale color of the optic papilla in early stage, and pale and clearly bounded primary optic nerve atrophy in late stage. (4) Ocular muscle paralysis The ocular manifestation of saddle area tumor is mainly visual acuity loss and visual field defect, and ocular movement disorder is less, and often appears in the late stage of the disease, and only when the tumor extends outward can the cranial nerve innervating ocular movement be involved, which causes ocular muscle paralysis and ocular movement disorder.