title: Microsurgical and Tractographic Anatomy of the Supplementary Motor Area Complex in Humans.
abstract: OBJECTIVE
  To evaluate the microsurgical anatomy of the fiber tract connections of the supplementary motor area (SMA) and pre-SMA, and examine its potential functional role with reference to clinical trials in the literature.
  
  
  METHODS
  Ten postmortem formalin-fixed human brains (20 sides) and 1 cadaveric head were prepared following Klingler's method. The fiber dissection was performed in a stepwise fashion, from lateral to medial and also from medial to lateral, under an operating microscope, with 3D images captured at each stage. Our findings were supported by in vivo magnetic resonance imaging tractography in 2 healthy subjects.
  
  
  RESULTS
  The connections of the SMA complex, composed of the pre-SMA and the SMA proper, are composed of short "U" association fibers and the superior longitudinal fasciculus I, cingulum, claustrocortical fibers, callosal fibers, corticospinal tract, frontal aslant tract, and frontostriatal tract. The claustrocortical fibers may play an important role in the integration of motor, language, and limbic functions of the SMA complex. The frontostriatal tract connects the pre-SMA to the putamen and caudate nucleus, and also forms parts of both the internal capsule and the dorsal external capsule.
  
  
  CONCLUSIONS
  The SMA complex has numerous connections throughout the cerebrum. An understanding of these connections is important for presurgical planning for lesions in the frontal lobe and helps explain symptoms related to SMA injury.
authors.affiliation: Department of Neurosurgery, University of Minnesota, Minneapolis, Minnesota, USA.
authors.forename: Baran
authors.initials: B
authors.lastname: Bozkurt
authors.affiliation: Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA.
authors.forename: Kaan
authors.initials: K
authors.lastname: Yagmurlu
authors.affiliation: Department of Radiology, College of Medicine, University of Florida, Gainesville, Florida, USA.
authors.forename: Erik H
authors.initials: EH
authors.lastname: Middlebrooks
authors.affiliation: Department of Neurosurgery, University of Minnesota, Minneapolis, Minnesota, USA.
authors.forename: Ali
authors.initials: A
authors.lastname: Karadag
authors.affiliation: Department of Neurosurgery, Bakirkoy Research and Training Hospital for Neurology, Neurosurgery, and Psychiatry, Istanbul, Turkey.
authors.forename: Talat Cem
authors.initials: TC
authors.lastname: Ovalioglu
authors.affiliation: Department of Radiology, University of Minnesota, Minneapolis, Minnesota, USA.
authors.forename: Bharathi
authors.initials: B
authors.lastname: Jagadeesan
authors.affiliation: Department of Neurosurgery, University of Minnesota, Minneapolis, Minnesota, USA.
authors.forename: Gauravjot
authors.initials: G
authors.lastname: Sandhu
authors.affiliation: Department of Neurosurgery, Cerrahpasa Medical School, University of Istanbul, Istanbul, Turkey.
authors.forename: Necmettin
authors.initials: N
authors.lastname: Tanriover
authors.affiliation: Department of Neurosurgery, University of Minnesota, Minneapolis, Minnesota, USA. Electronic address: andrew.w.grande@gmail.com.
authors.forename: Andrew W
authors.initials: AW
authors.lastname: Grande
mesh_terms: D002102:Cadaver; D002421:Caudate Nucleus / Q000033:anatomy & histology* / Q000000981:diagnostic imaging / Q000601:surgery; D003337:Corpus Callosum / Q000033:anatomy & histology / Q000000981:diagnostic imaging / Q000601:surgery; D038524:Diffusion Magnetic Resonance Imaging; D056324:Diffusion Tensor Imaging; D005625:Frontal Lobe / Q000033:anatomy & histology* / Q000000981:diagnostic imaging / Q000601:surgery; D064368:Healthy Volunteers; D006801:Humans; D021621:Imaging, Three-Dimensional; D008853:Microscopy; D008866:Microsurgery; D009044:Motor Cortex / Q000033:anatomy & histology* / Q000000981:diagnostic imaging / Q000601:surgery; D009434:Neural Pathways / Q000033:anatomy & histology / Q000000981:diagnostic imaging / Q000601:surgery; D011699:Putamen / Q000033:anatomy & histology* / Q000000981:diagnostic imaging / Q000601:surgery; D011712:Pyramidal Tracts / Q000033:anatomy & histology* / Q000000981:diagnostic imaging / Q000601:surgery
keywords: Cerebrum; Fiber dissection; Fiber tract; Frontal aslant tract; Frontal lobe; Supplementary motor area