Shah Harshal A, Mittelman Laura, Singha Souvik, Galvez Rosivel, Cavallaro Julianna, Yaffe Beril, Huang Grace, Silverstein Justin W, D'Amico Randy S
Department of Neurological Surgery, Lenox Hill Hospital, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, New York, NY, USA.
Department of Neurological Surgery, Lenox Hill Hospital, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, New York, NY, USA.
Clin Neurol Neurosurg. 2025 Feb;249:108726. doi: 10.1016/j.clineuro.2025.108726. Epub 2025 Jan 5.
Supplementary motor area (SMA) syndrome is characterized by contralateral akinesia and mutism, and frequently occurs following resection of tumors involving the superior frontal gyrus. The frontal aslant tract (FAT), involved in functional connectivity of the supplementary area and other related large-scale brain networks, is implicated in the pathogenesis of, and recovery from, SMA syndrome. However, intraoperative neuromonitoring of the FAT is inconsistent and poorly reproducible, leading to a high rate of postoperative SMA syndrome. We report the cases of two patients harboring lesions of the superior frontal gyrus: one cavernoma and one low grade glioma. Connectome imaging revealed involvement of functional networks implicated in SMA syndrome, as well as displacement of the FAT. A connectome-guided awake craniotomy was performed in both cases, and a combinatorial approach using awake language mapping and connectome-imaging guidance facilitated gross total resection of both patient's lesions without inducing SMA syndrome postoperatively. Functional and structural connectivity imaging through connectomics allows the identification of areas not traditionally considered eloquent, such as the SMA and FAT, and can help facilitate their preservation. Conserving the functional and structural connectivity of broader brain regions that are not traditionally deemed eloquent can improve patient outcomes.
辅助运动区（SMA）综合征的特征为对侧运动不能和缄默症，常发生于涉及额上回的肿瘤切除术后。额斜束（FAT）参与辅助运动区及其他相关大规模脑网络的功能连接，与SMA综合征的发病机制及恢复有关。然而，FAT的术中神经监测结果不一致且重复性差，导致术后SMA综合征发生率较高。我们报告了两例患有额上回病变的患者病例：一例海绵状血管瘤和一例低级别胶质瘤。连接组成像显示与SMA综合征相关的功能网络受累，以及FAT移位。两例均进行了连接组引导下的清醒开颅手术，采用清醒语言映射和连接组成像引导的联合方法，实现了两位患者病变的全切除，且术后未诱发SMA综合征。通过连接组学进行的功能和结构连接成像能够识别传统上不被视为明确功能区的区域，如SMA和FAT，并有助于对其进行保留。保留传统上不被视为明确功能区的更广泛脑区的功能和结构连接，可改善患者预后。
