Recruitment of Contralateral Supplementary Motor Area in Functional Recovery Following Medial Frontal Lobe Surgery: An fMRI Case Study.
OBJECTIVE
Supplementary motor area (SMA) syndrome, an executive disorder with motor and speech dysfunctions, is rather unpredictable with typically a complete or almost complete functional recovery within weeks or months. Compensatory mechanisms are associated with contralateral cortical recruitment of the lateral premotor circuitry. We sought to investigate the role of healthy SMA for motor recovery following surgery in the medial frontal lobe.


METHODS
A 48-year-old right-handed man presented with focal motor seizures. The diagnostic work-up revealed a low-grade glioma at the superior frontal gyrus. The patient was operated on with intraoperative monitoring of motor pathways, and resection was taken to the functional boundaries.


RESULTS
Postoperatively, the patient experienced a typical SMA syndrome that almost completely resolved in the long term. Motor recovery occurred concurrently with a shift of SMA activation to the healthy hemisphere together with an increased lateral premotor circuitry, especially for the hand map.


CONCLUSIONS
Our results confirm brain remodeling of the lateral premotor cortex, as previously described, and indicate that functional improvement is also paralleled with a shift of SMA activation toward the healthy hemisphere.
Division of Neurosurgery, State University of Rio de Janeiro - Surgical Specialties, Rio de Janeiro, Rio de Janeiro, Brazil.
Marcus Andre
MA
Acioly
Division of Neurosurgery, State University of Rio de Janeiro - Surgical Specialties, Rio de Janeiro, Rio de Janeiro, Brazil.
Alexandre Martins
AM
Cunha
Division of Neurosurgery, State University of Rio de Janeiro - Surgical Specialties, Rio de Janeiro, Rio de Janeiro, Brazil.
Maud
M
Parise
Department of Neuroimaging, I'Dor Neuroimaging Institute, Rio de Janeiro, Rio de Janeiro, Brazil.
Erika
E
Rodrigues
Department of Neuroimaging, I'Dor Neuroimaging Institute, Rio de Janeiro, Rio de Janeiro, Brazil.
Fernanda
F
Tovar-Moll
D005910:Glioma / Q000601:surgery*; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009044:Motor Cortex / Q000502:physiology*; D009473:Neuronal Plasticity / Q000502:physiology*; D017397:Prefrontal Cortex / Q000601:surgery*; D020127:Recovery of Function / Q000502:physiology*; D015173:Supratentorial Neoplasms / Q000601:surgery*