Department of Neurosurgery, AZ Delta, Roeselare, Belgium.
Department of Neurosurgery, Ghent University Hospital, C. Heymanslaan 10, 9000, Ghent, Belgium.
Neurosurg Rev. 2022 Feb;45(1):81-90. doi: 10.1007/s10143-021-01566-6. Epub 2021 May 15.
The supplementary motor area (SMA) syndrome is a frequently encountered clinical phenomenon associated with surgery of the dorsomedial prefrontal lobe. The region has a known motor sequencing function and the dominant pre-SMA specifically is associated with more complex language functions; the SMA is furthermore incorporated in the negative motor network. The SMA has a rich interconnectivity with other cortical regions and subcortical structures using the frontal aslant tract (FAT) and the frontostriatal tract (FST). The development of the SMA syndrome is positively correlated with the extent of resection of the SMA region, especially its medial side. This may be due to interruption of the nearby callosal association fibres as the contralateral SMA has a particular important function in brain plasticity after SMA surgery. The syndrome is characterized by a profound decrease in interhemispheric connectivity of the motor network hubs. Clinical improvement is related to increasing connectivity between the contralateral SMA region and the ipsilateral motor hubs. Overall, most patients know a full recovery of the SMA syndrome, however a minority of patients might continue to suffer from mild motor and speech dysfunction. Rarely, no recovery of neurological function after SMA region resection is reported.
辅助运动区（SMA）综合征是一种与背内侧前额叶手术相关的常见临床现象。该区域具有已知的运动序列功能，而优势的前 SMA 特别与更复杂的语言功能相关；SMA 还包含在负运动网络中。SMA 与其他皮质区域和皮质下结构有丰富的相互连接，使用额斜束（FAT）和额纹状体束（FST）。SMA 综合征的发展与 SMA 区域的切除范围呈正相关，特别是其内侧。这可能是由于邻近胼胝体联合纤维的中断，因为对侧 SMA 在 SMA 手术后大脑可塑性方面具有特殊重要的功能。该综合征的特征是运动网络枢纽的半球间连接性明显下降。临床改善与对侧 SMA 区域和同侧运动枢纽之间的连接增加有关。总体而言，大多数患者的 SMA 综合征完全恢复，但少数患者可能继续存在轻度运动和言语功能障碍。极少数情况下，SMA 区域切除后未见神经功能恢复。
