Article
Supplementary motor area syndrome in glioma surgery – towards a classification system based on clinical and imaging data
Das Syndrom des supplementär motorischen Areals in der Gliomchirurgie – eine Klassifikation basierend auf klinischen und bildgebenden Daten
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Authors
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Mehmet Tuncer
- Charité Universitätsmedizin, Klinik für Neurochirurgie, Berlin, Deutschland
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Lucius Fekonja
- Charité Universitätsmedizin, Klinik für Neurochirurgie, Berlin, Deutschland
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Stefanie Ott
- Universitätsklinikum Hamburg-Eppendorf, Klinik für Neurochirurgie, Hamburg, Deutschland
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Melina Engelhardt
- Charité Universitätsmedizin, Klinik für Neurochirurgie, Berlin, Deutschland
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Katharina Faust
- Charité Universitätsmedizin, Klinik für Neurochirurgie, Berlin, Deutschland
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Anna-Gila Karbe
- Charité Universitätsmedizin, Klinik für Neurochirurgie, Berlin, Deutschland
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Thomas Picht
- Charité Universitätsmedizin, Klinik für Neurochirurgie, Berlin, Deutschland
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Lasse Dührsen
- Universitätsklinikum Hamburg-Eppendorf, Klinik für Neurochirurgie, Hamburg, Deutschland
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Peter Vajkoczy
- Charité Universitätsmedizin, Klinik für Neurochirurgie, Berlin, Deutschland
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Julia Onken
- Charité Universitätsmedizin, Klinik für Neurochirurgie, Berlin, Deutschland
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Andreas Pfnür
- Universitätsklinik Ulm am Bezirkskrankenhaus Günzburg, Neurochirurgische Klinik, Günzburg, Deutschland
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Jan Coburger
- Universitätsklinik Ulm am Bezirkskrankenhaus Günzburg, Neurochirurgische Klinik, Günzburg, Deutschland
| Published: | June 4, 2021 |
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Outline
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Objective: Surgical resection of gliomas involving the supplementary motor area (SMA) frequently results in a symptom complex described as “SMA syndrome”, which is characterized by mostly transient contralateral hemiparesis and speech deficits. As factors potentially influencing the severity and and duration of symptoms remain elusive, we aim to further investigate the clinical outcome and potential predictors in a large, multicentric cohort of patients with diffuse gliomas.
Methods: Forty-five patients with diffuse gliomas located in the superior frontal gyrus were included in this retrospective study. Clinical and neurological status were assessed pre- and postoperatively, at discharge and during follow up. MRI data was obtained pre- and postoperatively. Preoperative tumorous infiltration as well as postoperative injury of cortical and subcortical areas were analyzed using atlas-based parcellation. Associations between clinical and image-based parameters were analyzed using group tests and correlation anlyses.
Results: Incidence of SMA syndrome was 76% (n=36). Main symptoms were hemiparesis, aphasia and mutism. Symptoms resolved within several hours to 42 days (median=1 day). Persistent deficits after 3 months were observed in 27 patients. Duration and severity of symptoms were independant of age, tumor size and extent of resection. Injury of the SMA proper was associated with immediate postoperative hemiparesis of the upper (p=0.045; cc=0.425) and lower extremity (p=0.012; cc=0.481). Injury of the corpus callosum was associated with longer duration (> 2 days) of motor symptoms (p=0.03; cc=0.317) and with occurrence of mutism (p<0.001; cc=0.519) and aphasia (p=0.041; cc=0.298). Mutism was additionally notably associated with injury of the pre-SMA (p=0.048; cc=0.289).
Conclusion: The present study provides novel insights regarding the factors associated with severity and duration of postoperative SMA syndrome in glioma surgery - while further reinforcing current hypotheses of the mechanisms enabling functional recovery after SMA lesion (interhemispheric connectivity). This data will help neurosurgeons in patient consultation and help improve patients´ compliance during recovery period by improved prediction of severity, duration and long-term outcome.
