title: Pre-operative fMRI localization of the supplementary motor area and its relationship with postoperative speech deficits.
abstract: BACKGROUND
  Neurosurgery of the supplementary motor area (SMA) is associated with transient speech defects. We investigated whether SMA laterality correlates with postoperative speech defects.
  
  
  METHODS
  The authors reviewed 17 patients with SMA-area lesion resection and preoperative language fMRI. SMA laterality was calculated by comparison of voxel activation in paired SMAs by hand-drawn regions of interest (ROIs) (drawn by a neuroradiologist), and compared with qualitative assessment by two neuroradiologists. Postoperative speech defects before and after surgery were assessed by chart review.
  
  
  RESULTS
  Six patients developed new speech defects that resolved within several months. Two of the patients had a pre-existing speech defect that had developed after prior SMA-area surgery. All these patients had left-sided lesions, while none of the four patients with a right-sided lesion developed a speech defect. Neuroradiologists' assessment of SMA laterality agreed with ROI calculation for the SMAs that were lateralized. However, for the SMAs in the "codominant" range by ROI, the neuroradiologists felt that all but one of the cases clearly lateralized, with the exception deemed indeterminate or codominant. No correlation between laterality of SMA and speech defect was identified. Twelve patients showed lateralization contralateral to the lesion.
  
  
  CONCLUSIONS
  fMRI lateralization does not correlate with transient speech defects that developed from SMA-area surgery. Qualitative/visual assessment of SMA laterality was superior to ROI calculation because of the close proximity and possible overlap of signal from midline SMA. A majority of patients showed SMA lateralization contralateral to the SMA lesion.
authors.affiliation: Department of Radiology, Memorial Sloan-Kettering Cancer Center, USA.
authors.forename: John K
authors.initials: JK
authors.lastname: Lyo
authors.affiliation: Department of Radiology, Memorial Sloan-Kettering Cancer Center, USA.
authors.forename: Julio
authors.initials: J
authors.lastname: Arevalo-Perez
authors.affiliation: Functional MRI Laboratory of the Department of Radiology, Memorial Sloan-Kettering Cancer Center, USA.
authors.forename: Nicole
authors.initials: N
authors.lastname: Petrovich Brennan
authors.affiliation: Functional MRI Laboratory of the Department of Radiology, Memorial Sloan-Kettering Cancer Center, USA Department of Medical Physics, Memorial Sloan-Kettering Cancer Center, USA peckk@mskcc.org.
authors.forename: Kyung K
authors.initials: KK
authors.lastname: Peck
authors.affiliation: Department of Radiology, Memorial Sloan-Kettering Cancer Center, USA Functional MRI Laboratory of the Department of Radiology, Memorial Sloan-Kettering Cancer Center, USA.
authors.forename: Andrei I
authors.initials: AI
authors.lastname: Holodny
mesh_terms: D000328:Adult; D001931:Brain Mapping; D001932:Brain Neoplasms / Q000473:pathology / Q000601:surgery*; D015331:Cohort Studies; D005260:Female; D007839:Functional Laterality; D059907:Functional Neuroimaging; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009044:Motor Cortex / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*; D011183:Postoperative Complications / Q000503:physiopathology*; D011300:Preoperative Care; D011832:Radiation Injuries / Q000473:pathology / Q000601:surgery*; D012189:Retrospective Studies; D013060:Speech / Q000502:physiology; D013064:Speech Disorders / Q000503:physiopathology*
keywords: SMA; fMRI; language; neurosurgery; speech