title: Glial tumors in brodmann area 6: spread pattern and relationships to motor areas.
abstract: The posterior frontal lobe of the brain houses Brodmann area 4, which is the primary motor cortex, and Brodmann area 6, which consists of the supplementary motor area on the medial portion of the hemisphere and the premotor cortex on the lateral portion. In this area, safe resection is dependent on accurate localization of the motor cortex and the central sulcus, which can usually be achieved by using thin-section imaging and confirmed by using other techniques. The most reliable anatomic landmarks are the "hand knob" area and the marginal ramus of the cingulate sulcus. Postoperatively, motor deficits can occur not only because of injury to primary motor cortex but also because of injury to the supplementary motor area. Unlike motor cortex injury, the supplementary motor area syndrome is transient, if it occurs at all. On the lateral hemisphere, motor and language deficits can also occur because of premotor cortex injury, but a dense motor deficit would indicate subcortical injury to the corticospinal tract. The close relationship of the subcortical motor fibers and premotor cortex is illustrated. In contrast to the more constant landmarks of the central sulcus and marginal ramus, which aid in preoperative localization, the variable interruptions in the precentral and cingulate sulci of the posterior frontal lobe seem to provide "cortical bridges" for spread of infiltrating gliomas.
authors.affiliation: From the Departments of Diagnostic Radiology (K.B.S., L.S.C., P.W., V.A.K., A.J.K.) and Neurosurgery (S.S.P.), University of Texas MD Anderson Cancer Center, PO Box 301402, 1400 Pressler St, Houston, TX 77030; Anatom-e Information Systems, Houston, Tex (L.A.H.); and Radiology Partners, Houston, Tex (J.D.H.).
authors.forename: Komal B
authors.initials: KB
authors.lastname: Shah
authors.forename: L Anne
authors.initials: LA
authors.lastname: Hayman
authors.forename: Lakshmi S
authors.initials: LS
authors.lastname: Chavali
authors.forename: Jackson D
authors.initials: JD
authors.lastname: Hamilton
authors.forename: Sujit S
authors.initials: SS
authors.lastname: Prabhu
authors.forename: Pattana
authors.initials: P
authors.lastname: Wangaryattawanich
authors.forename: Vinodh A
authors.initials: VA
authors.lastname: Kumar
authors.forename: Ashok J
authors.initials: AJ
authors.lastname: Kumar
mesh_terms: D059925:Anatomic Landmarks; D001932:Brain Neoplasms / Q000175:diagnosis* / Q000473:pathology / Q000601:surgery; D003287:Contrast Media; D005910:Glioma / Q000175:diagnosis* / Q000473:pathology / Q000601:surgery; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods*; D009044:Motor Cortex / Q000473:pathology* / Q000601:surgery
chemical_list: D003287:Contrast Media