title: Recurrent Supplementary Motor Area Syndrome Following Repeat Brain Tumor Resection Involving Supplementary Motor Cortex.
abstract: BACKGROUND
  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.
  
  
  OBJECTIVE
  To describe the presentation and clinical course of patients who developed recurrent SMA syndrome after redo resection of tumors involving the SMA.
  
  
  METHODS
  We performed a retrospective review of 15 patients who underwent repeated resection of low-grade glioma from the superior and middle frontal gyrus. Of these patients, we identified 6 cases of recurrent SMA syndrome.
  
  
  RESULTS
  Six patients 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 by using a combination of somatosensory evoked potentials and electrocortical stimulation mapping. Location of tumor and extent of resection was examined with magnetic resonance imaging.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Neurological Surgery, University of Washington, Seattle, Washington.
authors.forename: Taylor J
authors.initials: TJ
authors.lastname: Abel
authors.forename: Robert T
authors.initials: RT
authors.lastname: Buckley
authors.forename: Ryan P
authors.initials: RP
authors.lastname: Morton
authors.forename: Patrik
authors.initials: P
authors.lastname: Gabikian
authors.forename: Daniel L
authors.initials: DL
authors.lastname: Silbergeld
mesh_terms: D000328:Adult; D000368:Aged; D001931:Brain Mapping; D001932:Brain Neoplasms / Q000150:complications / Q000601:surgery*; D003399:Craniotomy / Q000009:adverse effects; D004558:Electric Stimulation; D005073:Evoked Potentials, Somatosensory / Q000502:physiology; D017809:Fatal Outcome; D005260:Female; D006801:Humans; D007802:Language; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009044:Motor Cortex / Q000601:surgery*; D010291:Paresis / Q000209:etiology* / Q000628:therapy; D011183:Postoperative Complications / Q000209:etiology / Q000628:therapy*; D012008:Recurrence; D012086:Reoperation / Q000009:adverse effects; D012189:Retrospective Studies; D012640:Seizures / Q000209:etiology* / Q000628:therapy; D013577:Syndrome