Recurrent Supplementary Motor Area Syndrome Following Repeat Brain Tumor Resection Involving Supplementary Motor Cortex.
Recurrent Supplementary Motor Area Syndrome Following Repeat Brain Tumor Resection Involving Supplementary Motor Cortex.
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DOI：
10.1227/neu.0000000000000847
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发表时间：
2015-09
期刊：
影响因子：
4.8
通讯作者：
Silbergeld DL
中科院分区：
文献类型：
--
作者：
Abel TJ;Buckley RT;Morton RP;Gabikian P;Silbergeld DL
辅助运动区 (SMA) 综合征发生在涉及 SMA 的手术后，其特征是对侧偏瘫，伴有或不伴有言语障碍（取决于主要 SMA 的参与情况），这种症状是短暂的，通常会在数周至数月内消退。先前尚未描述过重复开颅手术后复发性 SMA 综合征。在这篇手稿中，我们描述了在重新切除涉及 SMA 的肿瘤后出现复发性 SMA 综合征的患者的表现和临床病程。我们对 15 名接受额上回和额中回低级别胶质瘤（SFG、MFG）重复切除术的患者进行了回顾性研究。在这些患者中，我们发现了 6 例复发性 SMA 综合征。六名患者在初次和随后切除 SMA 附近的肿瘤后出现了 SMA 综合征。结合体感诱发电位 (SSEP) 和皮层电刺激测绘，对每位患者的口才运动和语言皮层进行术中定位。通过磁共振（MR）成像检查肿瘤的位置和切除范围。本系列文章表明，在重复切除涉及 SMA 的肿瘤的患者中，会出现复发性 SMA 综合征。复发性 SMA 综合征的存在为切除后邻近同侧皮质的 SMA 功能重组提供了支持。应告知患有 SMA 肿瘤复发的患者复发 SMA 综合征的可能性。
Supplementary motor area (SMA) syndrome occurs after surgery involving the SMA and is characterized by contralateral hemiparesis with or without speech impairment (dependent on involvement of the dominant SMA), which is transient and characteristically resolves over the course of weeks to months. Recurrent SMA syndrome after repeat craniotomy has not been previously described. In this manuscript, we describe the presentation and clinical course of patients who developed recurrent SMA syndrome after redo resection of tumors involving the SMA. We performed a retrospective review of 15 patients who underwent repeated resection of low grade glioma from the superior and middle frontal gyrus (SFG, MFG). Of these patients we identified six cases of recurrent SMA syndrome. Six patient had a documented SMA syndrome occurring after initial and subsequent resection of tumor in proximity to the SMA. Intraoperative localization of eloquent motor and language cortex was achieved in each patient using a combination of somatosensory evoked potentials (SSEPs) and electrocortical stimulation mapping. Location of tumor and extent of resection was examined with magnetic resonance (MR) imaging. This series demonstrates that recurrent SMA syndrome occurs in patients undergoing repeat resection of tumors involving the SMA. The presence of recurrent SMA syndrome provides support for reorganization of SMA function to adjacent ipsilateral cortex after resection. Patients with recurrent neoplasms of the SMA should be counseled on the possibility of recurrent SMA syndrome.