Xu Ya-Wen, Lin Peng, Yao Pei-Sen, Zheng Shu-Fa, Kang De-Zhi
Department of Neurosurgery, Neurosurgical Institute, The First Affiliated Hospital of Fujian Medical University, NO. 20 Chazhong Road, Taijiang District, Fuzhou, 350004, China.
Department of Pain Treatment, The First Affiliated Hospital, Fujian Medical University, Fuzhou, China.
Neuroradiology. 2021 Aug;63(8):1283-1292. doi: 10.1007/s00234-021-02669-z. Epub 2021 Feb 20.
The importance of supplementary motor area (SMA) for motor function and compensation for primary motor area (M1) has received increased attention.
We used diffusion tensor imaging (DTI) and transcranial magnetic stimulation (TMS) to evaluate structure and function of corticospinal projection originating from SMA. Fibers of corticospinal projection originating from M1 (CST) and SMA (ACST) were analyzed. ACST originating from mesial SMA area formed separate white matter bundles leaving the anterior part of M1 area, which then entered the posterior limb of the internal capsule. Projection and overlap of both CST and ACST were detected on medulla.
Fibers of contralesional ACST were more than that of ipsilesional ACST in patients with SMA tumors (p<0.05). In patients with SMA tumor, all patients experienced temporary akinesia postoperatively. Seven hundred forty-one fibers of ipsilateral ACST and no fibers of ipsilateral CST were detected in the patient with M1 glioma, while most of contralateral limb movement was preserved. MEP could be evoked by stimulating SMA area as well as M1 area. ACST originated from SMA area and projected to the medial medulla.
SMA area and ACST integrity contributed to contralateral motor function and were a compensation for M1 lesion and damaged CST.
辅助运动区（SMA）对运动功能的重要性以及对初级运动区（M1）的代偿作用已受到越来越多的关注。
我们使用弥散张量成像（DTI）和经颅磁刺激（TMS）来评估源自SMA的皮质脊髓投射的结构和功能。分析了源自M1（CST）和SMA（ACST）的皮质脊髓投射纤维。源自内侧SMA区的ACST形成独立的白质束离开M1区前部，然后进入内囊后肢。在延髓检测到CST和ACST的投射及重叠情况。
SMA肿瘤患者对侧ACST纤维多于同侧ACST纤维（p<0.05）。SMA肿瘤患者术后均出现暂时运动不能。M1胶质瘤患者检测到741条同侧ACST纤维，未检测到同侧CST纤维，而对侧肢体大部分运动得以保留。刺激SMA区以及M1区均可诱发运动诱发电位（MEP）。ACST源自SMA区并投射至延髓内侧。
SMA区和ACST完整性有助于对侧运动功能，是对M1病变和受损CST的一种代偿。
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