Background: Resection or damage of the supplementary motor area (SMA) is associated with the development of a transient negative motor response defined as SMA syndrome. The risk of neurological deficits after resection in the SMA has been reported to vary widely from 23% to 100%. Various influencing factors can be involved. However, since tumors in the SMA are relatively infrequent, most of the evidence for surgical treatment of these lesions is based on small, retrospective, single-center case series. Furthermore, previous studies focused only on a few variables, and our knowledge regarding the outcome of these patients is still limited. Objective: To better define the risk of neurological deficits after brain tumor resection in the SMA. Methods: We retrospectively reviewed 66 surgeries that involved the SMA for gliomas and metastasis in 53 patients from two separate centers. Out of those, 13 cases were recurrence of the disease. We carefully evaluated various clinical factors, preoperative neuroimaging, intraoperative neurophysiology monitoring, and anatomical factors. By using Fisher’s exact probability test, we examined the relationship between these factors and the occurrence of postoperative neurological deficits. Statistical significance was considered at ap-value of less than 0.05. Results: In 28 cases, patients experienced neurological deficits after surgery. Among those cases, 26 experienced partial SMA syndrome, one experienced complete SMA syndrome, and one experienced a permanent neurological deficit. The research found that the patient’s past medical history (p= 0.005), lack of intraoperative language mapping (p= 0.044), and extent of resection (p= 0.040) significantly influenced the occurrence of language deficits. Additionally, the proximity between the corticospinal tract and the tumor (p= 0.005) and fMRI activation of the SMA in response to motor tasks (p= 0.044) were found to correlate with the development of motor deficits. However, there was no correlation found between the lack of intraoperative monitoring of motor-evoked potentials (MEPs) and the development of motor deficits (p> 0.05). Conclusions: Certain pre-existing medical conditions may increase the risk of postoperative language deficits. Intraoperative language mapping can help prevent these deficits. The extent of resection, along with the anatomical characteristics of the resection cavity, correlates with postoperative outcomes. Tractography and fMRI can assist in predicting the risk of motor deficits. Although intraoperative MEP monitoring can help prevent permanent motor deficits, it does not appear to prevent the transient deficits characteristic of SMA syndrome. Further intraoperative studies are needed to refine mapping and monitoring strategies for tumors involving the SMA and pre-SMA.
背景：辅助运动区（SMA）的切除或损伤与一种称为SMA综合征的短暂性负性运动反应的发生相关。据报道，SMA区切除术后神经功能缺损的风险差异很大，从23%到100%不等，可能涉及多种影响因素。然而，由于SMA区肿瘤相对少见，关于这些病变手术治疗的大部分证据基于小样本、回顾性、单中心的病例系列研究。此外，既往研究仅关注少数变量，我们对于这些患者预后的认识仍然有限。 目的：旨在更明确地界定SMA区脑肿瘤切除术后神经功能缺损的风险。 方法：我们回顾性分析了来自两个独立中心的53例患者（其中13例为疾病复发）共66例涉及SMA区的胶质瘤和转移瘤手术。我们仔细评估了各种临床因素、术前神经影像学、术中神经生理学监测和解剖学因素。通过使用Fisher精确概率检验，我们检验了这些因素与术后神经功能缺损发生之间的关系。统计学显著性设定为p值小于0.05。 结果：28例患者在术后出现神经功能缺损。其中，26例出现部分性SMA综合征，1例出现完全性SMA综合征，1例出现永久性神经功能缺损。研究发现，患者的既往病史（p=0.005）、缺乏术中语言功能区定位（p=0.044）以及切除范围（p=0.040）显著影响语言功能缺损的发生。此外，皮质脊髓束与肿瘤的邻近程度（p=0.005）以及SMA区在运动任务中的fMRI激活（p=0.044）被发现与运动功能缺损的发生相关。然而，未发现缺乏术中运动诱发电位（MEP）监测与运动功能缺损发生之间存在相关性（p>0.05）。 结论：某些既存医学状况可能增加术后语言功能缺损的风险。术中语言功能区定位有助于预防此类缺损。切除范围以及切除腔的解剖学特征与术后结局相关。纤维束成像和fMRI有助于预测运动功能缺损的风险。虽然术中MEP监测有助于预防永久性运动功能缺损，但似乎不能预防SMA综合征特征性的短暂性缺损。需要进一步的术中研究来完善针对涉及SMA区及前SMA区肿瘤的定位和监测策略。
肿瘤(癌症)患者之家