title: The role of secondary motor and language cortices in morbidity and mortality: a retrospective functional MRI study of surgical planning for patients with intracranial tumors.
abstract: OBJECTIVE
  Functional MRI (fMRI) is commonly used by neurosurgeons preoperatively to identify brain regions associated with essential behaviors, such as language and motor abilities. In this study the authors investigated the relationship between patient morbidity and mortality and the distance from the tumor border area to functional activations in secondary motor and language cortices.
  
  
  METHODS
  Patients with primary or metastatic brain tumors who underwent preoperative fMRI motor and language mapping were selected from a large database of patients with tumors. The lesion-to-activation distance (LAD) was measured in each patient relative to the supplementary motor area (SMA) for motor tasks and the presupplementary motor area (pSMA) for language tasks. The association between LAD and the incidence of deficits was investigated using the Fisher exact tests of significance. The impact of other variables, including age, handedness, sex, and tumor grade, was also investigated. In a subset of patients, logistic regression was performed to identify the likelihood of deficits based on the LAD to primary and secondary regions. Finally, Mantel-Cox log-rank tests were performed to determine whether survival time was significantly related to the LAD to secondary motor and language areas.
  
  
  RESULTS
  A significant association was observed between the LAD to the SMA and the incidence of motor deficits, with the percentage of patients with deficits dropping for those in the LAD > 2 cm group. The relationship between the LAD to the pSMA and the incidence of language deficits was not significant. Logistic regression demonstrated that the LAD to primary sensorimotor cortex does affect the incidence of motor deficits, but that the LAD to SMA does not. Finally, the authors observed no relationship between the LAD to secondary regions and patient mortality rates.
  
  
  CONCLUSIONS
  These results demonstrate that the LAD to SMA structures does affect morbidity, although not to the extent of LAD to primary structures. In addition, motor deficits are significantly associated with LAD to secondary structures, but language deficits are not. This should be considered by neurosurgeons for patient consultation and preoperative planning.
authors.affiliation: Departments of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin 53705, USA.
authors.forename: Jed
authors.initials: J
authors.lastname: Voss
authors.forename: Timothy B
authors.initials: TB
authors.lastname: Meier
authors.forename: Robert
authors.initials: R
authors.lastname: Freidel
authors.forename: Bornali
authors.initials: B
authors.lastname: Kundu
authors.forename: Veena A
authors.initials: VA
authors.lastname: Nair
authors.forename: Ryan
authors.initials: R
authors.lastname: Holdsworth
authors.forename: John S
authors.initials: JS
authors.lastname: Kuo
authors.forename: Vivek
authors.initials: V
authors.lastname: Prabhakaran
mesh_terms: D000328:Adult; D001931:Brain Mapping / Q000379:methods; D001932:Brain Neoplasms / Q000175:diagnosis* / Q000401:mortality* / Q000601:surgery; D005260:Female; D005625:Frontal Lobe / Q000502:physiology*; D006801:Humans; D007802:Language; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009017:Morbidity; D009044:Motor Cortex / Q000502:physiology*; D011300:Preoperative Care / Q000379:methods; D012189:Retrospective Studies; D013702:Temporal Lobe / Q000502:physiology*
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