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Risk Factors for Neurological Deficits Following Brain Tumor Resection in the Supplementary Motor Area (SMA): A
Lucio De Maria1,2,3, Karl Schaller1, Daniel Kiss-Bodolay1
1Neurosurgery Unit, Department of Clinical Neurosciences, Geneva University Hospitals (HUG), 1205 Geneva, Switzerland.
Cancers
|April 26, 2025
Summary
Resection of the supplementary motor area (SMA) can cause neurological deficits. Preoperative medical history, intraoperative language mapping, and tumor resection extent influence language deficits, while tumor proximity to the corticospinal tract and fMRI predict motor deficits.
Area of Science:
- Neurosurgery
- Neuro-oncology
- Neurology
Background:
- Resection or damage to the supplementary motor area (SMA) can lead to SMA syndrome, a transient negative motor response.
- Neurological deficits post-SMA resection range widely (23%-100%), with limited evidence from small, retrospective studies.
- Factors influencing outcomes are not fully understood due to the rarity of SMA tumors.
Purpose of the Study:
- To define the risk of neurological deficits following brain tumor resection within the SMA.
- To investigate various clinical, imaging, and intraoperative factors associated with postoperative deficits.
Main Methods:
- Retrospective review of 66 surgeries for SMA gliomas and metastases in 53 patients across two centers.
- Evaluation of clinical factors, preoperative neuroimaging, intraoperative neurophysiology, and anatomical details.
- Fisher's exact probability test used to assess the relationship between factors and postoperative deficits (p<0.05).
Main Results:
- 28 out of 66 surgeries resulted in postoperative neurological deficits, including partial or complete SMA syndrome and one permanent deficit.
- Factors influencing language deficits: patient history (p=0.005), lack of intraoperative language mapping (p=0.044), and extent of resection (p=0.040).
- Factors influencing motor deficits: tumor proximity to corticospinal tract (p=0.005) and fMRI activation (p=0.044); no correlation with MEP monitoring (p>0.05).
Conclusions:
- Pre-existing conditions increase language deficit risk; intraoperative language mapping is crucial for prevention.
- Extent of resection and cavity anatomy impact outcomes; tractography and fMRI aid in predicting motor deficit risk.
- Intraoperative monitoring of motor-evoked potentials (MEPs) may prevent permanent motor deficits but not transient SMA syndrome deficits.
