Surgical resection of grade II astrocytomas in the superior frontal gyrus.
OBJECTIVE
Surgery in the superior frontal gyrus partially involving the supplementary motor area (SMA) may be followed by contralateral transient weakness and aphasia initially indistinguishable from damage to the primary motor cortex. However, recovery is different, and SMA deficits may resolve completely within days to weeks. No study has assessed the distinct postoperative deficits after tumor resection in the SMA on a homogeneous patient group.


METHODS
Twenty-four patients with World Health Organization Grade II astrocytomas in the superior frontal gyrus consecutively treated by surgery were studied. Degree and duration of postoperative deficits were evaluated according to tumor location and boundaries via magnetic resonance imaging scans, intraoperative neuromonitoring results, and extent of tumor resection.


RESULTS
Postoperatively, motor deficits were evident in 21 of 24 and speech deficits in 9 of 12 patients. Motor function quickly recovered in 11 and speech function in 3 patients. None of the 12 patients in whom the posterior tumor resection line was at a distance of more than 0.5 cm from the precentral sulcus experienced persistent motor deficits. Eight of these patients developed typical SMA syndrome with transient initiation difficulties. Seven of 12 patients in whom the tumor extended to the precentral sulcus still had motor deficits at the 12-month follow-up assessment.


CONCLUSIONS
Surgery for Grade II gliomas in the superior frontal gyrus is more likely to result in permanent morbidity when the resection is performed at a distance of less than 0.5 cm from the precentral gyrus or positive stimulation points. Therefore, cortical mapping of motor and speech function, in critical cases under local anesthesia with the patient as his or her own monitor, is recommended; resection should be tailored to obtain good functional outcome and maintain quality of life.
Peraud
Aurelia
A
Department of Neurosurgery, Klinikum Grobetahadern, Ludwig-Maximilians-University, Munich, Germany. aurelia.peraud@helios.med.uni-muenchen.de
Meschede
Magnus
M
Eisner
Wilhelm
W
Ilmberger
Josef
J
Reulen
Hans-Jürgen
HJ
D000328:Adult; D001254:Astrocytoma / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D001932:Brain Neoplasms / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D002540:Cerebral Cortex / Q000503:physiopathology; D004558:Electric Stimulation; D005260:Female; D005625:Frontal Lobe / Q000473:pathology; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009069:Movement Disorders / Q000209:etiology / Q000503:physiopathology; D019635:Neurosurgical Procedures / Q000009:adverse effects; D011184:Postoperative Period; D020127:Recovery of Function; D013064:Speech Disorders / Q000209:etiology / Q000503:physiopathology; D016896:Treatment Outcome