Background/Objectives:The purpose of this study was to investigate preoperative interhemispheric differences of the FAT in relation to the onset of postoperative SMA syndrome.Methods:This was a single-center retrospective analysis of patients who underwent surgical resection of diffuse gliomas involving the SMA between 2018 and 2022. Inclusion criteria were availability of preoperative and postoperative Magnetic Resonance Imaging, no previous surgery, and no neurological deficits at presentation. Diffusion-weighted data were processed by spherical deconvolution (SD) and diffusion tensor imaging tractography algorithms, and TrackVis was used to dissect the FAT of both hemispheres. The FAT data were analyzed for correlation with postoperative SMA syndrome onset.Results:N= 25 cases were included in the study, among whichn= 23 had preoperative bilaterally identifiable FAT by SD.N= 12 developed an SMA syndrome, 6 demonstrated a motor-only syndrome, 4 had a verbal-only syndrome, and 2 had mixed verbal and motor features. The SMA syndrome incidence was significantly more frequent in lower-grade gliomas (p= 0.005). On the tumor side, the FAT identified by SD was smaller than the contralateral (mean volume 6.53 cm3and 13.33 cm3, respectively,p< 0.001). In the 6 cases that developed a verbal SMA syndrome, a normalized FAT volume asymmetry (FAT-VA) demonstrated an asymmetry shifted towards the non-dominant side (mean FAT-VA = −0.68), while the cases with no postoperative verbal impairment had opposite asymmetry towards the dominant side (mean FAT-VA = 0.42,p= 0.010).Conclusions:Preoperative interhemispheric FAT volume asymmetry estimated according to functional dominance can predict postoperative onset of verbal SMA syndrome, with proportionally smaller FAT on the affected dominant hemisphere.
背景/目的：本研究旨在探讨术前额顶束（FAT）半球间体积差异与术后辅助运动区（SMA）综合征发生的关系。 方法：本研究为单中心回顾性分析，纳入2018年至2022年间接受弥漫性胶质瘤手术切除且肿瘤累及SMA的患者。纳入标准包括：具备术前及术后磁共振成像数据、无既往手术史、就诊时无神经功能缺损。采用球面反卷积（SD）与扩散张量成像纤维束追踪算法处理弥散加权数据，并运用TrackVis软件对双侧半球FAT进行分割。分析FAT数据与术后SMA综合征发生的相关性。 结果：共纳入25例病例，其中23例术前经SD识别出双侧FAT。12例出现SMA综合征，其中6例为纯运动型综合征，4例为纯言语型综合征，2例为混合型（言语及运动症状）。低级别胶质瘤中SMA综合征发生率显著更高（p=0.005）。肿瘤侧经SD识别的FAT体积小于对侧（平均体积分别为6.53 cm³和13.33 cm³，p<0.001）。在6例发生言语型SMA综合征的患者中，标准化FAT体积不对称性（FAT-VA）显示不对称性偏向非优势半球（平均FAT-VA=-0.68），而无术后言语障碍的病例则呈现相反的不对称性偏向优势半球（平均FAT-VA=0.42，p=0.010）。 结论：基于功能优势半球评估的术前FAT半球间体积不对称性可预测术后言语型SMA综合征的发生，表现为受累优势半球FAT体积相对较小。
Asymmetry of the Frontal Aslant Tract and Development of Supplementary Motor Area Syndrome
肿瘤(癌症)患者之家