Postoperative deficits and functional recovery following removal of tumors involving the dominant hemisphere supplementary motor area

Robert C. Rostomily Deparment of Neurological Surgery, University of Washington School of Medicine, Seattle, Washington

Search for other papers by Robert C. Rostomily in
Current site
Google Scholar
PubMed
Close
 M.D.
,
Mitchel S. Berger Deparment of Neurological Surgery, University of Washington School of Medicine, Seattle, Washington

Search for other papers by Mitchel S. Berger in
Current site
Google Scholar
PubMed
Close
 M.D.
,
George A. Ojemann Deparment of Neurological Surgery, University of Washington School of Medicine, Seattle, Washington

Search for other papers by George A. Ojemann in
Current site
Google Scholar
PubMed
Close
 M.D.
, and
Ettore Lettich Deparment of Neurological Surgery, University of Washington School of Medicine, Seattle, Washington

Search for other papers by Ettore Lettich in
Current site
Google Scholar
PubMed
Close
 R.E.E.G.T.
Restricted access

Purchase Now

USD  $45.00

JNS + Pediatrics - 1 year subscription bundle (Individuals Only)

USD  $525.00

JNS + Pediatrics + Spine - 1 year subscription bundle (Individuals Only)

USD  $624.00
USD  $45.00
USD  $525.00
USD  $624.00
Print or Print + Online Sign in

✓ The supplementary motor area (SMA) is a region located within each cerebral hemisphere at the posterior mesial border of the frontal lobe adjacent to the falx. The functional significance of this area has been somewhat unclear, and information regarding its influence on motor output has largely been based on evoked responses to direct stimulation in primates and humans. In this series of patients with primary and metastatic tumors involving the dominant hemisphere SMA, a distinct pattern of postoperative deficits and recovery has emerged which emphasizes the role of this critical area in the initiation of motor activity, including speech. Based upon this analysis, ablation of this region after first identifying the primary motor cortex may be accomplished without risk of permanent loss of motor activity or speech function, despite the initial severe deficits.

  • Collapse
  • Expand
  • 1.

    Alexander MP, & Schmitt MA: The aphasia syndrome of stroke in the left anterior cerebral artery. Arch Neurol 37:97100, 1980 Alexander MP, Schmitt MA: The aphasia syndrome of stroke in the left anterior cerebral artery. Arch Neurol 37:97–100, 1980

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 2.

    Arseni C, & Botez MI: Speech disturbances caused by tumours of the supplementary motor area. Acta Psychiatr Neurol Scand 36:279299, 1961 Arseni C, Botez MI: Speech disturbances caused by tumours of the supplementary motor area. Acta Psychiatr Neurol Scand 36:279–299, 1961

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 3.

    Berger MS, , Cohen WA, & Ojemann GA: Correlation of motor cortex brain mapping data with magnetic resonance imaging. J Neurosurg 72:383387, 1990 Berger MS, Cohen WA, Ojemann GA: Correlation of motor cortex brain mapping data with magnetic resonance imaging. J Neurosurg 72:383–387, 1990

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 4.

    Berger MS, , Ojemann GA, & Lettich E: Neurophysiological monitoring during astrocytoma surgery. Neurosurg Clin North Am 1:6580, 1990 Berger MS, Ojemann GA, Lettich E: Neurophysiological monitoring during astrocytoma surgery. Neurosurg Clin North Am 1:65–80, 1990

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 5.

    Braak H: A primitive gigantopyramidal field buried in the depth of the cingulate sulcus of the human brain. Brain Res 109:219233, 1976 Braak H: A primitive gigantopyramidal field buried in the depth of the cingulate sulcus of the human brain. Brain Res 109:219–233, 1976

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 6.

    Caplan LR, & Zervas NT: Speech arrest in a dextral with a right mesial frontal astrocytoma. Arch Neurol 35:252253, 1978 Caplan LR, Zervas NT: Speech arrest in a dextral with a right mesial frontal astrocytoma. Arch Neurol 35:252–253, 1978

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 7.

    Damasio AR, & Van Hoesen GW: Structure and function of the supplementary motor area. Neurology 30:359, 1980 Damasio AR, Van Hoesen GW: Structure and function of the supplementary motor area. Neurology 30:359, 1980

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 8.

    Dick JPR, , Benecke R, & Rothwell JC, et al: Simple and complex movements in a patient with infarction of the right supplementary motor area. Movement Disord 4:255266, 1986 Dick JPR, Benecke R, Rothwell JC, et al: Simple and complex movements in a patient with infarction of the right supplementary motor area. Movement Disord 4:255–266, 1986

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 9.

    Eccles JC: The initiation of voluntary movements by the supplementary motor area. Arch Psychiatr Nervenkr 231:423441, 1982 Eccles JC: The initiation of voluntary movements by the supplementary motor area. Arch Psychiatr Nervenkr 231:423–441, 1982

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 10.

    Fox PT, , Fox JM, & Raichle ME, et al: The role of cerebral cortex in the generation of voluntary saccades. A positron emission tomographic study. J Neurophysiol 54:348369, 1985 Fox PT, Fox JM, Raichle ME, et al: The role of cerebral cortex in the generation of voluntary saccades. A positron emission tomographic study. J Neurophysiol 54:348–369, 1985

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 11.

    Gelmers HJ: Non-paralytic motor disturbances and speech disorders: the role of the supplementary motor area. J Neurol Neurosurg Psychiatry 46:10521054, 1983 Gelmers HJ: Non-paralytic motor disturbances and speech disorders: the role of the supplementary motor area. J Neurol Neurosurg Psychiatry 46:1052–1054, 1983

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 12.

    Goldberg G: Supplementary motor area structure and function: review and hypotheses. Behav Brain Sci 8:567616, 1985 Goldberg G: Supplementary motor area structure and function: review and hypotheses. Behav Brain Sci 8:567–616, 1985

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 13.

    Green JR, , Angevine JB, & White JC Jr, et al: Significance of the supplementary motor area in partial seizures and in cerebral localization. Neurosurgery 6:6675, 1980 Green JR, Angevine JB, White JC Jr, et al: Significance of the supplementary motor area in partial seizures and in cerebral localization. Neurosurgery 6:66–75, 1980

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 14.

    Hutchins KD, , Martino MA, & Strick PL: Corticospinal projections from the medial wall of the hemisphere. Exp Brain Res 71:667672, 1988 Hutchins KD, Martino MA, Strick PL: Corticospinal projections from the medial wall of the hemisphere. Exp Brain Res 71:667–672, 1988

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 15.

    Jonas S: The supplementary motor region and speech emission. J Common Disord 14:349373, 1981 Jonas S: The supplementary motor region and speech emission. J Common Disord 14:349–373, 1981

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 16.

    Jürgens U: The efferent and afferent connections of the supplementary motor area. Brain Res 300:6381, 1984 Jürgens U: The efferent and afferent connections of the supplementary motor area. Brain Res 300:63–81, 1984

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 17.

    Laplane D, , Talairach J, & Meininger V, et al: Clinical consequences of corticectomies involving the supplementary motor area in man. J Neurol Sci 34:301314, 1977 Laplane D, Talairach J, Meininger V, et al: Clinical consequences of corticectomies involving the supplementary motor area in man. J Neurol Sci 34:301–314, 1977

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 18.

    Larsen B, , Skinhøj E, & Lassen NA: Variations in regional cortical blood flow in the right and left hemispheres during automatic speech. Brain 101:193209, 1978 Larsen B, Skinhøj E, Lassen NA: Variations in regional cortical blood flow in the right and left hemispheres during automatic speech. Brain 101:193–209, 1978

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 19.

    MacPherson J, , Wiesendanger M, & Marangoz C, et al: Corticospinal neurones of the supplementary motor area of monkeys. Exp Brain Res 48:8188, 1982 MacPherson J, Wiesendanger M, Marangoz C, et al: Corticospinal neurones of the supplementary motor area of monkeys. Exp Brain Res 48:81–88, 1982

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 20.

    Meador KJ, , Watson RT, & Bowers D, et al: Hypometria with hemispatial and limb motor neglect. Brain 109:293305, 1986 Meador KJ, Watson RT, Bowers D, et al: Hypometria with hemispatial and limb motor neglect. Brain 109:293–305, 1986

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 21.

    Morris HH III, , Dinner DS, & Lüders H, et al: Supplementary motor seizures: clinical and electroencephalographic findings. Neurology 38:10751082, 1988 Morris HH III, Dinner DS, Lüders H, et al: Supplementary motor seizures: clinical and electroencephalographic findings. Neurology 38:1075–1082, 1988

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 22.

    Ojemann G, , Ojemann J, & Lettich E, et al: Cortical language localization in left, dominant hemisphere. An electrical stimulation mapping investigation in 117 patients. J Neurosurg 71:316326, 1989 Ojemann G, Ojemann J, Lettich E, et al: Cortical language localization in left, dominant hemisphere. An electrical stimulation mapping investigation in 117 patients. J Neurosurg 71:316–326, 1989

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 23.

    Orgogozo JM, & Larsen B: Activation of the supplementary motor area during voluntary movement in man suggests it works as a supramotor area. Science 206:847850, 1979 Orgogozo JM, Larsen B: Activation of the supplementary motor area during voluntary movement in man suggests it works as a supramotor area. Science 206:847–850, 1979

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 24.

    Peled R, , Harnes B, & Borovich B, et al: Speech arrest and supplementary motor area seizures. Neurology 34:110111, 1984 Peled R, Harnes B, Borovich B, et al: Speech arrest and supplementary motor area seizures. Neurology 34:110–111, 1984

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 25.

    Penfield W, & Jasper HH: Epilepsy and the Functional Anatomy of the Human Brain. Boston: Little, Brown & Co, 1954 Penfield W, Jasper HH: Epilepsy and the Functional Anatomy of the Human Brain. Boston: Little, Brown & Co, 1954

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 26.

    Penfield W, & Roberts L: Speech and Brain Mechanisms. Princeton, NJ: Princeton University Press, 1959 Penfield W, Roberts L: Speech and Brain Mechanisms. Princeton, NJ: Princeton University Press, 1959

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 27.

    Penfield W, & Welch K: The suppplementary motor area of the cerebral cortex: a clinical and experimental study. Arch Neurol Psychiatry 66:289317, 1951 Penfield W, Welch K: The suppplementary motor area of the cerebral cortex: a clinical and experimental study. Arch Neurol Psychiatry 66:289–317, 1951

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 28.

    Roland PE, , Larsen B, & Lassen NA, et al: Supplementary motor area and other cortical areas in organization of voluntary movements in man. J Neurophysiol 43:118136, 1980 Roland PE, Larsen B, Lassen NA, et al: Supplementary motor area and other cortical areas in organization of voluntary movements in man. J Neurophysiol 43:118–136, 1980

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 29.

    Roland PE, , Meyer E, & Shibasaki T, et al: Regional cerebral blood flow changes in cortex and basal ganglia during voluntary movements in normal human volunteers. J Neurophysiol 48:467480, 1982 Roland PE, Meyer E, Shibasaki T, et al: Regional cerebral blood flow changes in cortex and basal ganglia during voluntary movements in normal human volunteers. J Neurophysiol 48:467–480, 1982

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 30.

    Rubens AB: Aphasia with infarction in the territory of the anterior cerebral artery. Cortex 11:239250, 1975 Rubens AB: Aphasia with infarction in the territory of the anterior cerebral artery. Cortex 11:239–250, 1975

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 31.

    Sanides F: The cyto-myeloarchitecture of the human frontal lobe and its relation to phylogenetic differentiation of the cerebral cortex. J Hirnforsch 6:269282, 1964 Sanides F: The cyto-myeloarchitecture of the human frontal lobe and its relation to phylogenetic differentiation of the cerebral cortex. J Hirnforsch 6:269–282, 1964

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 32.

    Schell GR, & Strick PL: The origin of thalamic inputs to the arcuate premotor and supplementary motor areas. J Neurosci 4:539560, 1984 Schell GR, Strick PL: The origin of thalamic inputs to the arcuate premotor and supplementary motor areas. J Neurosci 4:539–560, 1984

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 33.

    Talairach J, & Bancaud J: The supplementary motor area in man (anatomo-functional findings by stereo-electroencephalography in epilepsy). Int J Neurol 5:330347, 1966 Talairach J, Bancaud J: The supplementary motor area in man (anatomo-functional findings by stereo-electroencephalography in epilepsy). Int J Neurol 5:330–347, 1966

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 34.

    Van Buren JM, & Fedio P: Functional representation on the medial aspect of the frontal lobes in man. J Neurosurg 44:275289, 1976 Van Buren JM, Fedio P: Functional representation on the medial aspect of the frontal lobes in man. J Neurosurg 44:275–289, 1976

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 35.

    Verfaellie M, & Heilman KM: Response preparation and response inhibition after lesions of the medial frontal lobe. Arch Neurol 44:12651271, 1987 Verfaellie M, Heilman KM: Response preparation and response inhibition after lesions of the medial frontal lobe. Arch Neurol 44:1265–1271, 1987

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 36.

    Watson RT, , Fleet WS, & Gonzalez-Rothi L, et al: Apraxia and the supplementary motor area. Arch Neurol 43:787792, 1986 Watson RT, Fleet WS, Gonzalez-Rothi L, et al: Apraxia and the supplementary motor area. Arch Neurol 43:787–792, 1986

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 37.

    Wiesendanger M: Recent developments in studies of the supplementary motor area of primates. Rev Physiol Biochem Pharmacol 103:159, 1986 Wiesendanger M: Recent developments in studies of the supplementary motor area of primates. Rev Physiol Biochem Pharmacol 103:1–59, 1986

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 38.

    Wiesendanger M, & Wiesendanger R: The supplementary motor area in the light of recent investigations. Exp Brain Res Suppl 9:382392, 1984 Wiesendanger M, Wiesendanger R: The supplementary motor area in the light of recent investigations. Exp Brain Res Suppl 9:382–392, 1984

    • PubMed
    • Search Google Scholar
    • Export Citation

Metrics

All Time Past Year Past 30 Days
Abstract Views 1747 276 18
Full Text Views 459 37 2
PDF Downloads 343 45 0
EPUB Downloads 0 0 0