Language supplementary motor area syndrome correlated with dynamic changes in perioperative task-based functional MRI activations: case report

Quirarte, Jaime A.; Kumar, Vinodh A.; Liu, Ho Ling; Noll, Kyle R.; Wefel, Jeffrey S.; Lang, Frederick F.

doi:10.3171/2020.4.jns193250

Cited by 10 publications

(6 citation statements)

References 19 publications

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“…The contralateral, healthy SMA region plays a major role in functional restoration of neurologic function [1,10,46]. Slow growth of a LGG is associated with brain plasticity allowing resections of historically considered eloquent brain regions.…”

Section: Mechanisms Of Neuroplasticity Associated With Sma Syndrome Remissionmentioning

confidence: 99%

The supplementary motor area syndrome: a neurosurgical review

et al. 2021

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The supplementary motor area (SMA) syndrome is a frequently encountered clinical phenomenon associated with surgery of the dorsomedial prefrontal lobe. The region has a known motor sequencing function and the dominant pre-SMA specifically is associated with more complex language functions; the SMA is furthermore incorporated in the negative motor network. The SMA has a rich interconnectivity with other cortical regions and subcortical structures using the frontal aslant tract (FAT) and the frontostriatal tract (FST). The development of the SMA syndrome is positively correlated with the extent of resection of the SMA region, especially its medial side. This may be due to interruption of the nearby callosal association fibres as the contralateral SMA has a particular important function in brain plasticity after SMA surgery. The syndrome is characterized by a profound decrease in interhemispheric connectivity of the motor network hubs. Clinical improvement is related to increasing connectivity between the contralateral SMA region and the ipsilateral motor hubs. Overall, most patients know a full recovery of the SMA syndrome, however a minority of patients might continue to suffer from mild motor and speech dysfunction. Rarely, no recovery of neurological function after SMA region resection is reported.

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Section: Mechanisms Of Neuroplasticity Associated With Sma Syndrome Remissionmentioning

confidence: 99%

The supplementary motor area syndrome: a neurosurgical review

et al. 2021

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“…Their main results are discussed in the following sections according to the cognitive function investigated in the attempt to draw general conclusions about the clinical relevance of integrating pre-surgical neuropsychological assessment and fMRI. As a qualitative result, we found two more studies reporting only the details of the neuropsychological evaluation administered postoperatively [50,51].…”

Section: Resultsmentioning

confidence: 97%

Neuropsychological Evaluation and Functional Magnetic Resonance Imaging Tasks in the Preoperative Assessment of Patients with Brain Tumors: A Systematic Review

Pertichetti,

Corbo,

Belotti

et al. 2023

Brain Sciences

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Background: Current surgical treatment of gliomas relies on a function-preserving, maximally safe resection approach. Functional Magnetic Resonance Imaging (fMRI) is a widely employed technology for this purpose. A preoperative neuropsychological evaluation should accompany this exam. However, only a few studies have reported both neuropsychological tests and fMRI tasks for preoperative planning—the current study aimed to systematically review the scientific literature on the topic. Methods: PRISMA guidelines were followed. We included studies that reported both neuropsychological tests and fMRI. Exclusion criteria were: no brain tumors, underage patients, no preoperative assessment, resting-state fMRI only, or healthy sample population/preclinical studies. Results: We identified 123 papers, but only 15 articles were included. Eight articles focused on language; three evaluated cognitive performance; single papers studied sensorimotor cortex, prefrontal functions, insular cortex, and cerebellar activation. Two qualitative studies focused on visuomotor function and language. According to some authors, there was a strong correlation between performance in presurgical neuropsychological tests and fMRI. Several papers suggested that selecting well-adjusted and individualized neuropsychological tasks may enable the development of personalized and more efficient protocols. The fMRI findings may also help identify plasticity phenomena to avoid unintentional damage during neurosurgery. Conclusions: Most studies have focused on language, the most commonly evaluated cognitive function. The correlation between neuropsychological and fMRI results suggests that altered functions during the neuropsychological assessment may help identify patients who could benefit from an fMRI and, possibly, functions that should be tested. Neuropsychological evaluation and fMRI have complementary roles in the preoperative assessment.

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“…Another important fact is that the contralateral SMA is essential in restoring function [ 39 – 41 ]. Brain plasticity compensates for ipsilateral function loss due to tumor growth by recruiting the contralateral SMA using interhemispheric connections.…”

Section: Discussionmentioning

confidence: 99%

Permanent deterioration of fine motor skills after the resection of tumors in the supplementary motor area

Maurer,

Butenschoen,

Kelm

et al. 2024

Neurosurg Rev

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Supplementary motor area syndrome (SMAS) represents a common neurosurgical sequela. The incidence and time frame of its occurrence have yet to be characterized after surgery for brain tumors. We examined patients suffering from a brain tumor preoperatively, postoperatively, and during follow-up examinations after three months, including fine motor skills testing and transcranial magnetic stimulation (TMS). 13 patients suffering from a tumor in the dorsal part of the superior frontal gyrus underwent preoperative, early postoperative, and 3-month follow-up testing of fine motor skills using the Jebsen-Taylor Hand Function Test (JHFT) and the Nine-Hole Peg Test (NHPT) consisting of 8 subtests for both upper extremities. They completed TMS for cortical motor function mapping. Test completion times (TCTs) were recorded and compared. No patient suffered from neurological deficits before surgery. On postoperative day one, we detected motor deficits in two patients, which remained clinically stable at a 3-month follow-up. Except for page-turning, every subtest indicated a significant worsening of function, reflected by longer TCTs (p < 0.05) in the postoperative examinations for the contralateral upper extremity (contralateral to the tumor manifestation). At 3-month follow-up examinations for the contralateral upper extremity, each subtest indicated significant worsening compared to the preoperative status despite improvement to the immediate postoperative level. We also detected significantly longer TCTs (p < 0.05) postoperatively in the ipsilateral upper extremity. This study suggests a long-term worsening of fine motor skills even three months after SMA tumor resection, indicating the necessity of targeted physical therapy for these patients.

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Language supplementary motor area syndrome correlated with dynamic changes in perioperative task-based functional MRI activations: case report

Cited by 10 publications

References 19 publications

The supplementary motor area syndrome: a neurosurgical review

The supplementary motor area syndrome: a neurosurgical review

Neuropsychological Evaluation and Functional Magnetic Resonance Imaging Tasks in the Preoperative Assessment of Patients with Brain Tumors: A Systematic Review

Permanent deterioration of fine motor skills after the resection of tumors in the supplementary motor area

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