Endo Yukari, Saito Yoshiaki, Otsuki Taisuke, Takahashi Akio, Nakata Yasuhiro, Okada Kazue, Hirozane Mayumi, Kaido Takanobu, Kaneko Yuu, Takada Eiko, Okazaki Tetsuya, Enokizno Takashi, Saito Takashi, Komaki Hirofumi, Nakagawa Eiji, Sugai Kenji, Sasaki Masayuki
Department of Child Neurology, National Center of Neurology and Psychiatry, 4-1-1 Ogawahigachi-cho, Kodaira, Tokyo 187-8551, Japan.
Department of Child Neurology, National Center of Neurology and Psychiatry, 4-1-1 Ogawahigachi-cho, Kodaira, Tokyo 187-8551, Japan.
Brain Dev. 2014 Jan;36(1):74-9. doi: 10.1016/j.braindev.2013.01.002. Epub 2013 Feb 8.
An 8-year-old boy underwent a resection for focal cortical dysplasia at the left supplementary motor area (SMA) for the treatment of intractable epilepsy. The manifestations of SMA syndrome, such as transient mutism and right hemiparesis, resolved within a few weeks. Verbal disfluency and impaired executive function, accompanied by impulsivity and distractibility, persisted for more than 12months. The verbal and behavioral problems caused serious difficulties in the school life of the patient, until they became less evident at 18months after surgery. Tractography performed 18months after surgery revealed a defect in the subportion of fronto-parietal association fibers within the left superior longitudinal fascicles. Verbal influency can persist with unusually long duration after resection of SMA during childhood. Although not discernible on the routine neuroimaging, white matter damage beneath the SMA region could result in serious disabilities in executive function. These complications should be recognized for the prediction and assessment of deficits in children after surgical intervention involving this region.
一名8岁男孩因治疗顽固性癫痫在左侧辅助运动区（SMA）接受了局灶性皮质发育异常切除术。SMA综合征的表现，如短暂性缄默症和右侧偏瘫，在几周内得到缓解。言语不流畅和执行功能受损，伴有冲动和注意力分散，持续了12个月以上。言语和行为问题给患者的学校生活带来了严重困难，直到术后18个月才变得不那么明显。术后18个月进行的纤维束成像显示左侧上纵束内额顶叶联合纤维的一部分存在缺陷。儿童期SMA切除术后，言语不流畅可能会持续异常长的时间。虽然在常规神经影像学上无法察觉，但SMA区域下方的白质损伤可能会导致执行功能严重受损。在对涉及该区域的手术干预后儿童的缺陷进行预测和评估时，应认识到这些并发症。
