Risk factor analysis of the development of new neurological deficits following supplementary motor area resection

Abstract

Object Supplementary motor area (SMA) resection often induces postoperative contralateral hemiparesis or speech disturbance. This study was performed to assess the neurological impairments that often follow SMA resection and to assess the risk factors associated with these postoperative deficits. Methods The records for patients who had undergone SMA resection for pharmacologically intractable epilepsy between 1994 and 2010 were gleaned from an epilepsy surgery database and retrospectively reviewed in this study. Results Forty-three patients with pharmacologically intractable epilepsy underwent SMA resection with intraoperative cortical stimulation and mapping while under awake anesthesia. The mean patient age was 31.7 years (range 15–63 years), and the mean duration and frequency of seizures were 10.4 years (range 0.1–30 years) and 14.6 per month (range 0.1–150 per month), respectively. Pathological examination of the brain revealed cortical dysplasia in 18 patients (41.9%), tumors in 16 patients (37.2%), and other lesions in 9 patients (20.9%). The mean duration of the follow-up period was 84.0 months (range 24–169 months). After SMA resection, 23 patients (53.5%) experienced neurological deficits. Three patients (7.0%) experienced permanent deficits, and 20 (46.5%) experienced symptoms that were transient. All permanent deficits involved contralateral weakness, whereas the transient symptoms patients experienced were varied, including contralateral weaknesses in 15, apraxia in 1, sensory disturbances in 1, and dysphasia in 6. Thirteen patients recovered completely within 1 month. Univariate analysis revealed that resection of the SMA proper, a shorter lifetime seizure history (< 10 years), and resection of the cingulate gyrus in addition to the SMA were associated with the development of neurological deficits (p = 0.078, 0.069, and 0.023, respectively). Cingulate gyrus resection was the only risk factor identified on multivariate analysis (p = 0.027, OR 6.530, 95% CI 1.234–34.562). Conclusions Resection of the cingulate gyrus in addition to the SMA was significantly associated with the development of postoperative neurological impairment.

Extension of diffuse low-grade gliomas beyond radiological borders as shown by the coregistration of histopathological and magnetic resonance imaging data

“…8C). After surgery, the patient suffered from an inability to initiate voluntary movements, most likely due to resection of the supplementary motor area, 34 but he made a full recovery within 1 month.…”

Brain‐responsive neurostimulation in patients with medically intractable seizures arising from eloquent and other neocortical areas

“…Depending on the area of brain resected, 17-67% of patients who undergo focal cortical resection of extratemporal areas report new or increased neurologic deficits after surgery. [3][4][5][6][7][8] Patients who are not good candidates for cortical resection because of risk to neurologic function-such as patients with seizure onsets in eloquent cortex-may consider brain-responsive stimulation as a therapeutic option.…”

The crossed frontal aslant tract: A possible pathway involved in the recovery of supplementary motor area syndrome

“…SMA syndrome may also lead to mutism and speech hesitancy when lesions involve the dominant hemisphere (Ryu, Chun, & You, 2013). In patients with SMA syndrome, the brain shows a remarkable capacity for compensation after unilateral lesions as roughly 90% of patients recover from SMA insult over the course of weeks to months (Kim et al, 2013;Rosenberg et al, 2010).…”