Supplementary Motor Area Syndrome after Brain Tumor Surgery: A Systematic Review.
Supplementary Motor Area Syndrome after Brain Tumor Surgery: A Systematic Review.
复制标题
脑肿瘤手术后的补充运动区综合征：系统评价。
DOI：
10.1016/j.wneu.2022.06.080
复制
发表时间：
2022
影响因子：
2
通讯作者：
R. D’Amico
中科院分区：
文献类型：
--
作者：
P. Palmisciano;A. Haider;K. Balasubramanian;N. Dadario;F. Robertson;Justin W. Silverstein;R. D’Amico
研究背景额叶肿瘤手术后可发生辅助运动区综合征（SMAS），其临床表现和预后各不相同.我们回顾了文献对术后SMAS后脑tumor surgery.MethodsPubMed，Web of Science，Scopus，和科克伦进行了搜索后的PRISMA指南，包括研究报告SMAS后脑tumor surgery.ResultsWe包括31项研究，包括236例患者。胶质瘤占94.5%，低级别占61.4%。病变位于左侧半球占64.4%，其中辅助运动区占61.4%，扣带回占20.8%。45名（19.1%）和26名（11%）患者完成了纤维束造影和功能性磁共振成像评价。46.3%的患者实现了大体全切除，69.4%的患者实现了SMA完全切除。共有215例手术（91.1%）使用了术中神经监测，主要包括直接皮层/皮层下刺激（56.4%）、运动（33.9%）和体感（25.4%）诱发电位。术后SMAS症状发生在术后24小时内，其特征为运动障碍（97%），包括轻瘫（68.6%）和偏瘫（16.1%），以及言语障碍（53%），包括犹豫（24.2%）和缄默症（22%）。平均SMAS持续时间为45天（范围，1-365天），188例患者（79.7%）完全缓解，46例患者（19.5%）部分改善。48例（20.3%）患者有持续的症状，主要是言语犹豫（60.4%）和精细运动障碍（45.8%）。术前标测和术中神经监测可辅助切除并预测结局。神经可塑性和大脑半球间的连接在解决问题中起着重要作用。
BackgroundSupplementary motor area syndrome (SMAS) may occur after frontal tumor surgery, with variable presentation and outcomes. We reviewed the literature on postoperative SMAS after brain tumor resection.MethodsPubMed, Web of Science, Scopus, and Cochrane were searched following the PRISMA guidelines to include studies reporting SMAS after brain tumor resection.ResultsWe included 31 studies encompassing 236 patients. Most tumors were gliomas (94.5%), frequently of low grade (61.4%). Most lesions were located on the left hemisphere (64.4%), involving the supplementary motor area (61.4%) and the cingulate gyrus (20.8%). Tractography and functional magnetic resonance imaging evaluation were completed in 45 (19.1%) and 26 (11%) patients. Gross total resection was achieved in 46.3% patients and complete SMA resection in 69.4%. A total of 215 procedures (91.1%) used intraoperative neuromonitoring mostly consisting of direct cortical/subcortical stimulation (56.4%), motor (33.9%), and somatosensory (25.4%) evoked potentials. Postoperative SMAS symptoms occurred within 24 hours after surgery, characterized by motor deficits (97%), including paresis (68.6%) and hemiplegia (16.1%), and speech disorders (53%), including hesitancy (24.2%) and mutism (22%). Average SMAS duration was 45 days (range, 1–365 days), with total resolution occurring in 188 patients (79.7%) and partial improvement in 46 (19.5%). Forty-eight patients (20.3%) had persisting symptoms, mostly speech hesitancy (60.4%) and fine motor disorders (45.8%).ConclusionsPostoperative SMAS may occur within the first 24 hours after mesial frontal tumor surgery. Preoperative mapping and intraoperative neuromonitoring may assist resection and predict outcomes. Neuroplasticity and interhemispheric connectivity play a major role in resolution.