title: Preoperative mapping of the supplementary motor area in patients harboring tumors in the medial frontal lobe.
abstract: OBJECTIVE
  Injury to the supplementary motor area (SMA) is thought to be responsible for transient motor and speech deficits following resection of tumors involving the medial frontal lobe. Because direct intraoperative localization of SMA is difficult, the authors hypothesized that functional magnetic resonance (fMR) imaging might be useful in predicting the risk of postoperative deficits in patients who undergo resection of tumors in this region.
  
  
  METHODS
  Twelve patients who had undergone fMR imaging mapping while performing speech and motor tasks prior to excision of their tumor, that is, based on anatomical landmarks involving the SMA, were included in this study. The distance between the edge of the tumor and the center of SMA activation was measured and was correlated with the risk of incurring postoperative neurological deficits. In every patient, SMA activation was noted in the superior frontal gyrus on preoperative fMR imaging. Two speech and two motor deficits typical of SMA injury were observed in three of the 12 patients. The two speech deficits occurred in patients with tumors involving the dominant hemisphere, whereas one of the motor deficits occurred in a patient with a tumor in the nondominant hemisphere. The risk of developing a postoperative speech or motor deficit was 100% when the distance between the SMA and the tumor was 5 mm or less. When the distance between SMA activation and the lesion was greater than 5 mm, the risk of developing a motor or a speech deficit was 0% (p = 0.0007).
  
  
  CONCLUSIONS
  Early data from this study indicated that fMR imaging might be useful in localizing the SMA and in determining the risk of postoperative deficits in patients who undergo resection of tumors located in the medial frontal lobe.
authors.affiliation: Department of Radiology, University of Wisconsin School of Medicine, Madison, Wisconsin 53792, USA.
authors.forename: Lindsey
authors.initials: L
authors.lastname: Nelson
authors.forename: Samir
authors.initials: S
authors.lastname: Lapsiwala
authors.forename: Victor M
authors.initials: VM
authors.lastname: Haughton
authors.forename: Jane
authors.initials: J
authors.lastname: Noyes
authors.forename: Amir H
authors.initials: AH
authors.lastname: Sadrzadeh
authors.forename: Chad H
authors.initials: CH
authors.lastname: Moritz
authors.forename: M Elizabeth
authors.initials: ME
authors.lastname: Meyerand
authors.forename: Behnam
authors.initials: B
authors.lastname: Badie
mesh_terms: D000328:Adult; D001931:Brain Mapping; D001932:Brain Neoplasms / Q000503:physiopathology* / Q000601:surgery*; D005260:Female; D005625:Frontal Lobe; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009044:Motor Cortex / Q000503:physiopathology*; D009068:Movement / Q000502:physiology; D013060:Speech / Q000502:physiology