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Alonso-Vanegas MA, San-Juan D, Buentello García RM, Castillo-Montoya C, Sentíes-Madrid H, Mascher EB, Bialik PS, Trenado C. Long-term surgical results of supplementary motor area epilepsy surgery. J Neurosurg 2017; 127:1153-1159. [PMID: 28156248 DOI: 10.3171/2016.8.jns16333] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Supplementary motor area (SMA) epilepsy is a well-known clinical condition; however, long-term surgical outcome reports are scarce and correspond to small series or isolated case reports. The aim of this study is to present the surgical results of SMA epilepsy patients treated at 2 reference centers in Mexico City. METHODS For this retrospective descriptive study (1999-2014), 52 patients underwent lesionectomy and/or corticectomy of the SMA that was guided by electrocorticography (ECoG). The clinical, neurophysiological, neuroimaging, and pathological findings are described. The Engel scale was used to classify surgical outcome. Descriptive statistics, Student t-test, and Friedman, Kruskal-Wallis, and chi-square tests were used. RESULTS Of these 52 patients, the mean age at epilepsy onset was 26.3 years, and the mean preoperative seizure frequency was 14 seizures per month. Etiologies included low-grade tumors in 28 (53.8%) patients, cortical dysplasia in 17 (32.7%) patients, and cavernomas in 7 (13.5%) patients. At a mean follow-up of 5.7 years (range 1-10 years), 32 patients (61%) were classified as Engel Class I, 16 patients (31%) were classified as Engel Class II, and 4 (8%) patients were classified as Engel Class III. Overall seizure reduction was significant (p = 0.001). The absence of early postsurgical seizures and lesional etiology were associated with the outcome of Engel Class I (p = 0.05). Twenty-six (50%) patients had complications in the immediate postoperative period, all of which resolved completely with no residual neurological deficits. CONCLUSIONS Surgery for SMA epilepsy guided by ECoG using a multidisciplinary and multimodality approach is a safe, feasible procedure that shows good seizure control, moderate morbidity, and no mortality.
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Affiliation(s)
- Mario A Alonso-Vanegas
- Departments of 1 Neurosurgery and.,Clinical Neurophysiology, Centro Neurológico ABC, Centro Médico ABC Santa Fe, Mexico City
| | - Daniel San-Juan
- Clinical Neurophysiology, National Institute of Neurology and Neurosurgery, Mexico City.,Clinical Neurophysiology, Centro Neurológico ABC, Centro Médico ABC Santa Fe, Mexico City
| | | | | | - Horacio Sentíes-Madrid
- Department of Neurology, National Institute of Medical Science and Nutrition, Mexico City, Mexico ; and
| | | | - Paul Shkurovick Bialik
- Clinical Neurophysiology, Centro Neurológico ABC, Centro Médico ABC Santa Fe, Mexico City
| | - Carlos Trenado
- Institute of Clinical Neuroscience and Medical Psychology, University Hospital Düsseldorf, Germany
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Işık S, Akakın A, Ekşi MŞ, Yılmaz B, Aksoy T, Konakçı M, Toktaş ZO, Kılıç T. Bilateral Central Foot Drop in a Pediatric Patient. Pediatr Neurosurg 2017; 52:62-66. [PMID: 27427994 DOI: 10.1159/000447409] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2016] [Accepted: 06/02/2016] [Indexed: 11/19/2022]
Abstract
Foot drop is an inability to dorsiflex the ankle and toe. Primary causes of foot drop are compression or lesion of the 5th lumbar nerve and entrapment of the peroneal nerve at the head of the fibula. Rarely, some central nervous system lesions lead to foot drop. A 16-year-old boy was admitted with blunt head trauma that had happened in an assault. The muscle strength of the bilateral tibialis anterior, bilateral extensor digitorum longus and bilateral extensor digitorum brevis were Medical Research Council grade 1. Deep tendon reflexes of both ankles were hyperactive, with bilateral clonus and bilateral Babinski sign. There were cerebral contusions with peripheral edema in both motor strip areas extending anteriorly into the frontal lobes, with right-sided epidural-subdural hematoma. On brain MRI, the superior sagittal sinus was open. The epidural-subdural hematoma did not progress in its dimensions. The patient was treated conservatively. He recovered fully with regression of the contusions and epidural-subdural hematoma 4 months after the trauma. Foot drop due to upper motor neuron pathologies is more spastic in nature, different from what happens following lumbar disc herniation or peroneal nerve dysfunction. Treatment of central foot drop should be planned according to the underlying pathology.
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Affiliation(s)
- Semra Işık
- Department of Neurosurgery, Hakkari State Hospital, Hakkari, Turkey
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Bulubas L, Sabih J, Wohlschlaeger A, Sollmann N, Hauck T, Ille S, Ringel F, Meyer B, Krieg SM. Motor areas of the frontal cortex in patients with motor eloquent brain lesions. J Neurosurg 2016; 125:1431-1442. [DOI: 10.3171/2015.11.jns152103] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE
Because of its huge clinical potential, the importance of premotor areas for motor function itself and plastic reshaping due to tumors or ischemic brain lesions has received increased attention. Thus, in this study the authors used navigated transcranial magnetic stimulation (nTMS) to investigate whether tumorous brain lesions induce a change in motor cortex localization in the human brain.
METHODS
Between 2010 and 2013, nTMS motor mapping was performed in a prospective cohort of 100 patients with brain tumors in or adjacent to the rolandic cortex. Spatial data analysis was performed by normalization of the individual motor maps and creation of overlays according to tumor location. Analysis of motor evoked potential (MEP) latencies was performed regarding mean overall latencies and potentially polysynaptic latencies, defined as latencies longer than 1 SD above the mean value. Hemispheric dominance, lesion location, and motor-function deficits were also considered.
RESULTS
Graphical analysis showed that motor areas were not restricted to the precentral gyrus. Instead, they spread widely in the anterior-posterior direction. An analysis of MEP latency showed that mean MEP latencies were shortest in the precentral gyrus and longest in the superior and middle frontal gyri. The percentage of latencies longer than 1 SD differed widely across gyri. The dominant hemisphere showed a greater number of longer latencies than the nondominant hemisphere (p < 0.0001). Moreover, tumor location–dependent changes in distribution of polysynaptic latencies were observed (p = 0.0002). Motor-function deficit did not show any statistically significant effect.
CONCLUSIONS
The distribution of primary and polysynaptic motor areas changes in patients with brain tumors and highly depends on tumor location. Thus, these data should be considered for resection planning.
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Affiliation(s)
- Lucia Bulubas
- 1Department of Neurosurgery,
- 2TUM-Neuroimaging Center, and
| | - Jamil Sabih
- 1Department of Neurosurgery,
- 2TUM-Neuroimaging Center, and
| | - Afra Wohlschlaeger
- 3Section of Neuroradiology, Department of Radiology, Klinikum rechts der Isar, Technische Universität München, Germany
| | - Nico Sollmann
- 1Department of Neurosurgery,
- 2TUM-Neuroimaging Center, and
| | - Theresa Hauck
- 1Department of Neurosurgery,
- 2TUM-Neuroimaging Center, and
| | - Sebastian Ille
- 1Department of Neurosurgery,
- 2TUM-Neuroimaging Center, and
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Vassal M, Charroud C, Deverdun J, Le Bars E, Molino F, Bonnetblanc F, Boyer A, Dutta A, Herbet G, Moritz-Gasser S, Bonafé A, Duffau H, de Champfleur NM. Recovery of functional connectivity of the sensorimotor network after surgery for diffuse low-grade gliomas involving the supplementary motor area. J Neurosurg 2016; 126:1181-1190. [PMID: 27315027 DOI: 10.3171/2016.4.jns152484] [Citation(s) in RCA: 78] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The supplementary motor area (SMA) syndrome is a well-studied lesional model of brain plasticity involving the sensorimotor network. Patients with diffuse low-grade gliomas in the SMA may exhibit this syndrome after resective surgery. They experience a temporary loss of motor function, which completely resolves within 3 months. The authors used functional MRI (fMRI) resting state analysis of the sensorimotor network to investigate large-scale brain plasticity between the immediate postoperative period and 3 months' follow-up. METHODS Resting state fMRI was performed preoperatively, during the immediate postoperative period, and 3 months postoperatively in 6 patients with diffuse low-grade gliomas who underwent partial surgical excision of the SMA. Correlation analysis within the sensorimotor network was carried out on those 3 time points to study modifications of its functional connectivity. RESULTS The results showed a large-scale reorganization of the sensorimotor network. Interhemispheric connectivity was decreased in the postoperative period, and increased again during the recovery process. Connectivity between the lesion side motor area and the contralateral SMA rose to higher values than in the preoperative period. Intrahemispheric connectivity was decreased during the immediate postoperative period and had returned to preoperative values at 3 months after surgery. CONCLUSIONS These results confirm the findings reported in the existing literature on the plasticity of the SMA, showing large-scale modifications of the sensorimotor network, at both inter- and intrahemispheric levels. They suggest that interhemispheric connectivity might be a correlate of SMA syndrome recovery.
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Affiliation(s)
- Matthieu Vassal
- Departments of 1 Neurosurgery and.,Neuroradiology.,Institut d'Imagerie Fonctionnelle Humaine, and.,Institut des Neurosciences de Montpellier, INSERM U1051, Centre Hospitalier Régional Universitaire de Montpellier; and
| | - Céline Charroud
- Neuroradiology.,Institut d'Imagerie Fonctionnelle Humaine, and
| | - Jérémy Deverdun
- Neuroradiology.,Institut d'Imagerie Fonctionnelle Humaine, and.,Institut des Neurosciences de Montpellier, INSERM U1051, Centre Hospitalier Régional Universitaire de Montpellier; and.,Institut de Génomique Fonctionnelle, UMR 5203-INSERM U661.,Laboratoire Charles Coulomb, CNRS UMR 5221, and
| | - Emmanuelle Le Bars
- Neuroradiology.,Institut d'Imagerie Fonctionnelle Humaine, and.,Laboratoire Charles Coulomb, CNRS UMR 5221, and
| | - François Molino
- Institut de Génomique Fonctionnelle, UMR 5203-INSERM U661.,Laboratoire Charles Coulomb, CNRS UMR 5221, and
| | - Francois Bonnetblanc
- Laboratoire d'Informatique, de Robotique et de Microélectronique de Montpellier, CNRS UMR5506, Université de Montpellier, Montpellier, France
| | - Anthony Boyer
- Laboratoire d'Informatique, de Robotique et de Microélectronique de Montpellier, CNRS UMR5506, Université de Montpellier, Montpellier, France
| | - Anirban Dutta
- Laboratoire d'Informatique, de Robotique et de Microélectronique de Montpellier, CNRS UMR5506, Université de Montpellier, Montpellier, France
| | - Guillaume Herbet
- Departments of 1 Neurosurgery and.,Institut des Neurosciences de Montpellier, INSERM U1051, Centre Hospitalier Régional Universitaire de Montpellier; and
| | - Sylvie Moritz-Gasser
- Departments of 1 Neurosurgery and.,Institut des Neurosciences de Montpellier, INSERM U1051, Centre Hospitalier Régional Universitaire de Montpellier; and
| | - Alain Bonafé
- Neuroradiology.,Institut d'Imagerie Fonctionnelle Humaine, and.,Institut des Neurosciences de Montpellier, INSERM U1051, Centre Hospitalier Régional Universitaire de Montpellier; and
| | - Hugues Duffau
- Departments of 1 Neurosurgery and.,Institut des Neurosciences de Montpellier, INSERM U1051, Centre Hospitalier Régional Universitaire de Montpellier; and
| | - Nicolas Menjot de Champfleur
- Neuroradiology.,Institut d'Imagerie Fonctionnelle Humaine, and.,Institut des Neurosciences de Montpellier, INSERM U1051, Centre Hospitalier Régional Universitaire de Montpellier; and.,Laboratoire Charles Coulomb, CNRS UMR 5221, and
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Abel TJ, Buckley RT, Morton RP, Gabikian P, Silbergeld DL. Recurrent Supplementary Motor Area Syndrome Following Repeat Brain Tumor Resection Involving Supplementary Motor Cortex. Neurosurgery 2016; 11 Suppl 3:447-55; discussion 456. [PMID: 26087004 DOI: 10.1227/neu.0000000000000847] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Supplementary motor area (SMA) syndrome occurs after surgery involving the SMA and is characterized by contralateral hemiparesis with or without speech impairment (dependent on involvement of the dominant SMA), which is transient and characteristically resolves over the course of weeks to months. Recurrent SMA syndrome after repeat craniotomy has not been previously described. OBJECTIVE To describe the presentation and clinical course of patients who developed recurrent SMA syndrome after redo resection of tumors involving the SMA. METHODS We performed a retrospective review of 15 patients who underwent repeated resection of low-grade glioma from the superior and middle frontal gyrus. Of these patients, we identified 6 cases of recurrent SMA syndrome. RESULTS Six patients had a documented SMA syndrome occurring after initial and subsequent resection of tumor in proximity to the SMA. Intraoperative localization of eloquent motor and language cortex was achieved in each patient by using a combination of somatosensory evoked potentials and electrocortical stimulation mapping. Location of tumor and extent of resection was examined with magnetic resonance imaging. CONCLUSION This series demonstrates that recurrent SMA syndrome occurs in patients undergoing repeat resection of tumors involving the SMA. The presence of recurrent SMA syndrome provides support for reorganization of SMA function to adjacent ipsilateral cortex after resection. Patients with recurrent neoplasms of the SMA should be counseled on the possibility of recurrent SMA syndrome.
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Affiliation(s)
- Taylor J Abel
- Department of Neurological Surgery, University of Washington, Seattle, Washington
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Baciu M, Boudiaf N, Cousin E, Perrone-Bertolotti M, Pichat C, Fournet N, Chainay H, Lamalle L, Krainik A. Functional MRI evidence for the decline of word retrieval and generation during normal aging. AGE (DORDRECHT, NETHERLANDS) 2016; 38:3. [PMID: 26711670 PMCID: PMC5005885 DOI: 10.1007/s11357-015-9857-y] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/20/2015] [Accepted: 11/06/2015] [Indexed: 05/19/2023]
Abstract
This fMRI study aimed to explore the effect of normal aging on word retrieval and generation. The question addressed is whether lexical production decline is determined by a direct mechanism, which concerns the language operations or is rather indirectly induced by a decline of executive functions. Indeed, the main hypothesis was that normal aging does not induce loss of lexical knowledge, but there is only a general slowdown in retrieval mechanisms involved in lexical processing, due to possible decline of the executive functions. We used three tasks (verbal fluency, object naming, and semantic categorization). Two groups of participants were tested (Young, Y and Aged, A), without cognitive and psychiatric impairment and showing similar levels of vocabulary. Neuropsychological testing revealed that older participants had lower executive function scores, longer processing speeds, and tended to have lower verbal fluency scores. Additionally, older participants showed higher scores for verbal automatisms and overlearned information. In terms of behavioral data, older participants performed as accurate as younger adults, but they were significantly slower for the semantic categorization and were less fluent for verbal fluency task. Functional MRI analyses suggested that older adults did not simply activate fewer brain regions involved in word production, but they actually showed an atypical pattern of activation. Significant correlations between the BOLD (Blood Oxygen Level Dependent) signal of aging-related (A > Y) regions and cognitive scores suggested that this atypical pattern of the activation may reveal several compensatory mechanisms (a) to overcome the slowdown in retrieval, due to the decline of executive functions and processing speed and (b) to inhibit verbal automatic processes. The BOLD signal measured in some other aging-dependent regions did not correlate with the behavioral and neuropsychological scores, and the overactivation of these uncorrelated regions would simply reveal dedifferentiation that occurs with aging. Altogether, our results suggest that normal aging is associated with a more difficult access to lexico-semantic operations and representations by a slowdown in executive functions, without any conceptual loss.
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Affiliation(s)
- M Baciu
- Univ. Grenoble Alpes, LPNC, F-38040, Grenoble, France.
- CNRS, LPNC UMR 5105, F-38040, Grenoble, France.
| | - N Boudiaf
- Univ. Grenoble Alpes, LPNC, F-38040, Grenoble, France
- CNRS, LPNC UMR 5105, F-38040, Grenoble, France
| | - E Cousin
- Univ. Grenoble Alpes, LPNC, F-38040, Grenoble, France
- CNRS, LPNC UMR 5105, F-38040, Grenoble, France
- UMS IRMaGe CHU Grenoble, Univ. Grenoble Alpes, F-38043, Grenoble, France
| | - M Perrone-Bertolotti
- Univ. Grenoble Alpes, LPNC, F-38040, Grenoble, France
- CNRS, LPNC UMR 5105, F-38040, Grenoble, France
| | - C Pichat
- Univ. Grenoble Alpes, LPNC, F-38040, Grenoble, France
- CNRS, LPNC UMR 5105, F-38040, Grenoble, France
| | - N Fournet
- CNRS, LPNC UMR 5105, F-38040, Grenoble, France
- Univ. Savoie Montblanc, LPNC, F-73000, Chambéry, France
| | - H Chainay
- Laboratoire d'Etude des Mécanismes Cognitifs, Université Lumière Lyon 2, F-69676, Bron, France
| | - L Lamalle
- UMS IRMaGe CHU Grenoble, Univ. Grenoble Alpes, F-38043, Grenoble, France
| | - A Krainik
- UMS IRMaGe CHU Grenoble, Univ. Grenoble Alpes, F-38043, Grenoble, France
- GIN Univ. Grenoble Alpes, F-38043, Grenoble, France
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Ibe Y, Tosaka M, Horiguchi K, Sugawara K, Miyagishima T, Hirato M, Yoshimoto Y. Resection extent of the supplementary motor area and post-operative neurological deficits in glioma surgery. Br J Neurosurg 2016; 30:323-9. [PMID: 26760482 DOI: 10.3109/02688697.2015.1133803] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Objective The supplementary motor area (SMA) is important for the prediction of post-operative symptoms after surgical resection of gliomas. We investigated the relationships between clinical factors and the resection range of SMA gliomas, and the post-operative neurological symptoms. Methods We retrospectively studied 18 consecutive surgeries for gliomas involving the SMA proper performed in 13 patients. Seven cases were recurrence of the tumour. Clinical factors and details of specific resection of the SMA proper (resection of posterior part, medial wall) and cingulate motor area (CMA) were examined. Results Eight cases suffered new post-operative neurological deficits. Six of these eight cases had transient deficits. Permanent deficits persisted in two cases with partial weakness or paresis, after rapid improvement of post-operative global weakness or hemiplegia, respectively. The risk of post-operative neurological deficits was not associated with the resection of the posterior part of the SMA proper or the CMA, but was associated with resection of the medial wall of the SMA proper. Surgery for recurrent tumour was associated with post-operative neurological deficits. The medial wall was frequently resected in recurrent cases. Discussion The frequency of post-operative neurological symptoms, including SMA syndrome, may be higher after resection of the medial wall of the SMA proper compared with the resection of only the lateral surface of the SMA proper.
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Affiliation(s)
- Yoko Ibe
- a Department of Neurosurgery , Gunma University Graduate School of Medicine , Maebashi , Japan
| | - Masahiko Tosaka
- a Department of Neurosurgery , Gunma University Graduate School of Medicine , Maebashi , Japan
| | - Keishi Horiguchi
- a Department of Neurosurgery , Gunma University Graduate School of Medicine , Maebashi , Japan
| | - Kenichi Sugawara
- a Department of Neurosurgery , Gunma University Graduate School of Medicine , Maebashi , Japan
| | - Takaaki Miyagishima
- a Department of Neurosurgery , Gunma University Graduate School of Medicine , Maebashi , Japan
| | - Masafumi Hirato
- a Department of Neurosurgery , Gunma University Graduate School of Medicine , Maebashi , Japan
| | - Yuhei Yoshimoto
- a Department of Neurosurgery , Gunma University Graduate School of Medicine , Maebashi , Japan
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Abstract
Functional magnetic resonance imaging (fMRI) maps the spatiotemporal distribution of neural activity in the brain under varying cognitive conditions. Since its inception in 1991, blood oxygen level-dependent (BOLD) fMRI has rapidly become a vital methodology in basic and applied neuroscience research. In the clinical realm, it has become an established tool for presurgical functional brain mapping. This chapter has three principal aims. First, we review key physiologic, biophysical, and methodologic principles that underlie BOLD fMRI, regardless of its particular area of application. These principles inform a nuanced interpretation of the BOLD fMRI signal, along with its neurophysiologic significance and pitfalls. Second, we illustrate the clinical application of task-based fMRI to presurgical motor, language, and memory mapping in patients with lesions near eloquent brain areas. Integration of BOLD fMRI and diffusion tensor white-matter tractography provides a road map for presurgical planning and intraoperative navigation that helps to maximize the extent of lesion resection while minimizing the risk of postoperative neurologic deficits. Finally, we highlight several basic principles of resting-state fMRI and its emerging translational clinical applications. Resting-state fMRI represents an important paradigm shift, focusing attention on functional connectivity within intrinsic cognitive networks.
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Affiliation(s)
- Bradley R Buchbinder
- Department of Radiology, Division of Neuroradiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
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Yagmurlu K, Vlasak AL, Rhoton AL. Three-dimensional topographic fiber tract anatomy of the cerebrum. Neurosurgery 2015; 11 Suppl 2:274-305; discussion 305. [PMID: 25950888 DOI: 10.1227/neu.0000000000000704] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The fiber tracts of the cerebrum may be a more important determinant of resection limits than the cortex. Better knowledge of the 3-dimensional (3-D) anatomic organization of the fiber pathways is important in planning safe and accurate surgery for lesions within the cerebrum. OBJECTIVE To examine the topographic anatomy of fiber tracts and subcortical gray matter of the human cerebrum and their relationships with consistent cortical, ventricular, and nuclear landmarks. METHODS Twenty-five formalin-fixed human brains and 4 whole cadaveric heads were examined by fiber dissection technique and ×6 to ×40 magnification. The fiber tracts and central core structures, including the insula and basal ganglia, were examined and their relationships captured in 3-D photography. The depth between the surface of the cortical gyri and selected fiber tracts was measured. RESULTS The topographic relationships of the important association, projection, and commissural fasciculi within the cerebrum and superficial cortical landmarks were identified. Important landmarks with consistent relationships to the fiber tracts were the cortical gyri and sulci, limiting sulci of the insula, nuclear masses in the central core, and lateral ventricles. The fiber tracts were also organized in a consistent pattern in relation to each other. The anatomic findings are briefly compared with functional data from clinicoradiological analysis and intraoperative stimulation of fiber tracts. CONCLUSION An understanding of the 3-D anatomic organization of the fiber tracts of the brain is essential in planning safe and accurate cerebral surgery.
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Affiliation(s)
- Kaan Yagmurlu
- Department of Neurosurgery, University of Florida, College of Medicine, Gainesville, Florida
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60
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Rech F, Herbet G, Moritz-Gasser S, Duffau H. Somatotopic organization of the white matter tracts underpinning motor control in humans: an electrical stimulation study. Brain Struct Funct 2015; 221:3743-53. [PMID: 26459143 DOI: 10.1007/s00429-015-1129-1] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2015] [Accepted: 10/04/2015] [Indexed: 10/23/2022]
Abstract
The somatotopic organization of the primary motor cortex is well documented. However, a possible somatotopy of the network involved in motor control, i.e., eliciting negative motor phenomena during electrostimulation, is unknown in humans, particularly at the subcortical level. Here, we performed electrical stimulation mapping in awake patients operated for gliomas, to study the distribution of the white matter tracts subserving movement control of the lower limb, upper limb(s), and speech. Eighteen patients underwent awake surgery for frontal low-grade gliomas, by using intraoperative subcortical electrostimulation mapping to search interference with movement of the leg, arm(s), and face. We assessed the negative motor responses and their distribution throughout the tracts located under premotor areas. The corresponding stimulation sites were reported on a standard brain template for visual analysis and between-subjects comparisons. During stimulation of the white matter underneath the dorsal premotor cortex and supplementary motor area, rostral to the corticospinal tracts, all patients experienced cessation of the movement of lower and upper limbs, of bimanual coordination, and/or speech. These subcortical sites were somatotopically distributed. Indeed, stimulation of the fibers from mesial to lateral directions and from posterior to anterior directions evoked arrest of movement of the lower limb (mesially and posteriorly), upper limb(s), and face/speech (laterally and anteriorly). There were no postoperative permanent deficits. This is the first evidence of a somatotopic organization of the white matter bundles underpinning movement control in humans. A better knowledge of the distribution of this motor control network may be helpful in neurosciences and neurosurgery.
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Affiliation(s)
- Fabien Rech
- Department of Neurosurgery, CHU Nancy, Nancy, France
| | - Guillaume Herbet
- Department of Neurosurgery, Gui de Chauliac Hospital, Montpellier University Medical Center, 80 Avenue Augustin Fliche, 34295, Montpellier, France.,Team "Plasticity of Central Nervous System, Stem Cells and Glial Tumors", INSERM U1051, Institute for Neurosciences of Montpellier, Montpellier, France
| | - Sylvie Moritz-Gasser
- Department of Neurosurgery, Gui de Chauliac Hospital, Montpellier University Medical Center, 80 Avenue Augustin Fliche, 34295, Montpellier, France.,Team "Plasticity of Central Nervous System, Stem Cells and Glial Tumors", INSERM U1051, Institute for Neurosciences of Montpellier, Montpellier, France
| | - Hugues Duffau
- Department of Neurosurgery, Gui de Chauliac Hospital, Montpellier University Medical Center, 80 Avenue Augustin Fliche, 34295, Montpellier, France. .,Team "Plasticity of Central Nervous System, Stem Cells and Glial Tumors", INSERM U1051, Institute for Neurosciences of Montpellier, Montpellier, France.
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Stippich C, Blatow M, Garcia M. Task-Based Presurgical Functional MRI in Patients with Brain Tumors. CLINICAL FUNCTIONAL MRI 2015. [DOI: 10.1007/978-3-662-45123-6_4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
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Vergani F, Lacerda L, Martino J, Attems J, Morris C, Mitchell P, Thiebaut de Schotten M, Dell'Acqua F. White matter connections of the supplementary motor area in humans. J Neurol Neurosurg Psychiatry 2014; 85:1377-85. [PMID: 24741063 DOI: 10.1136/jnnp-2013-307492] [Citation(s) in RCA: 125] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
INTRODUCTION The supplementary motor area (SMA) is frequently involved by brain tumours (particularly WHO grade II gliomas). Surgery in this area can be followed by the 'SMA syndrome', characterised by contralateral akinesia and mutism. Knowledge of the connections of the SMA can provide new insights on the genesis of the SMA syndrome, and a better understanding of the challenges related to operating in this region. METHODS White matter connections of the SMA were studied with both postmortem dissection and advance diffusion imaging tractography. Postmortem dissections were performed according to the Klingler technique. 12 specimens were fixed in 10% formalin and frozen at -15°C for 2 weeks. After thawing, dissection was performed with blunt dissectors. For diffusion tractography, high-resolution diffusion imaging datasets from 10 adult healthy controls from the Human Connectome Project database were used. Whole brain tractography was performed using a spherical deconvolution approach. RESULTS Five main connections were identified in both postmortem dissections and tractography reconstructions: (1) U-fibres running in the precentral sulcus, connecting the precentral gyrus and the SMA; (2) U-fibres running in the cingulate sulcus, connecting the SMA with the cingulate gyrus; (3) frontal 'aslant' fascicle, directly connecting the SMA with the pars opercularis of the inferior frontal gyrus; (4) medial fibres connecting the SMA with the striatum; and (5) SMA callosal fibres. Good concordance was observed between postmortem dissections and diffusion tractography. CONCLUSIONS The SMA shows a wide range of white matter connections with motor, language and lymbic areas. Features of the SMA syndrome (akinesia and mutism) can be better understood on the basis of these findings.
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Affiliation(s)
- Francesco Vergani
- Department of Neurosurgery, Royal Victoria Infirmary, Newcastle upon Tyne, UK Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, UK
| | - Luis Lacerda
- Natbrainlab, Department of Neuroimaging, Institute of Psychiatry, King's College London, London, UK
| | - Juan Martino
- Department of Neurological Surgery, Hospital Universitario Marqués de Valdecilla and Instituto de Formación e Investigación Marqués de Valdecilla (IFIMAV), Santander, Cantabria, Spain
| | - Johannes Attems
- Institute for Ageing and Health, Newcastle University, Newcastle upon Tyne, UK
| | - Christopher Morris
- Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, UK Medical Toxicology Centre, Newcastle University, Newcastle upon Tyne, UK
| | - Patrick Mitchell
- Department of Neurosurgery, Royal Victoria Infirmary, Newcastle upon Tyne, UK Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, UK
| | - Michel Thiebaut de Schotten
- Natbrainlab, Department of Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, King's College London, London, UK Université Pierre et Marie Curie-Paris 6, Centre de Recherche de l'Institut du Cerveau et de la Moelle épinière (CRICM), UMRS 975, INSERM U 975, CNRS UMR, Paris, France
| | - Flavio Dell'Acqua
- Natbrainlab, Department of Neuroimaging, Institute of Psychiatry, King's College London, London, UK NIHR Biomedical Research Centre for Mental Health at South London and Maudsley NHS Foundation Trust and King's College London, Institute of Psychiatry, London, UK
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Potgieser ARE, de Jong BM, Wagemakers M, Hoving EW, Groen RJM. Insights from the supplementary motor area syndrome in balancing movement initiation and inhibition. Front Hum Neurosci 2014; 8:960. [PMID: 25506324 PMCID: PMC4246659 DOI: 10.3389/fnhum.2014.00960] [Citation(s) in RCA: 63] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2014] [Accepted: 11/11/2014] [Indexed: 11/24/2022] Open
Abstract
The supplementary motor area (SMA) syndrome is a characteristic neurosurgical syndrome that can occur after unilateral resection of the SMA. Clinical symptoms may vary from none to a global akinesia, predominantly on the contralateral side, with preserved muscle strength and mutism. A remarkable feature is that these symptoms completely resolve within weeks to months, leaving only a disturbance in alternating bimanual movements. In this review we give an overview of the old and new insights from the SMA syndrome and extrapolate these findings to seemingly unrelated diseases and symptoms such as Parkinson's disease (PD) and tics. Furthermore, we integrate findings from lesion, stimulation and functional imaging studies to provide insight in the motor function of the SMA.
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Affiliation(s)
- A. R. E. Potgieser
- Department of Neurosurgery, University Medical Center Groningen, University of GroningenGroningen, Netherlands
| | - B. M. de Jong
- Department of Neurology, University Medical Center Groningen, University of GroningenGroningen, Netherlands
| | - M. Wagemakers
- Department of Neurosurgery, University Medical Center Groningen, University of GroningenGroningen, Netherlands
| | - E. W. Hoving
- Department of Neurosurgery, University Medical Center Groningen, University of GroningenGroningen, Netherlands
| | - R. J. M. Groen
- Department of Neurosurgery, University Medical Center Groningen, University of GroningenGroningen, Netherlands
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64
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Duffau H. The huge plastic potential of adult brain and the role of connectomics: New insights provided by serial mappings in glioma surgery. Cortex 2014; 58:325-37. [DOI: 10.1016/j.cortex.2013.08.005] [Citation(s) in RCA: 173] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2013] [Revised: 07/28/2013] [Accepted: 08/08/2013] [Indexed: 12/27/2022]
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65
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Kinoshita M, de Champfleur NM, Deverdun J, Moritz-Gasser S, Herbet G, Duffau H. Role of fronto-striatal tract and frontal aslant tract in movement and speech: an axonal mapping study. Brain Struct Funct 2014; 220:3399-412. [DOI: 10.1007/s00429-014-0863-0] [Citation(s) in RCA: 125] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2014] [Accepted: 07/29/2014] [Indexed: 10/24/2022]
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66
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Ter Minassian A, Ricalens E, Nguyen The Tich S, Dinomais M, Aubé C, Beydon L. The presupplementary area within the language network: a resting state functional magnetic resonance imaging functional connectivity analysis. Brain Connect 2014; 4:440-53. [PMID: 24939724 DOI: 10.1089/brain.2014.0263] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
The presupplementary motor area (pre-SMA) is involved in volitional selection. Despite the lateralization of the language network and different functions for both pre-SMA, few studies have reported the lateralization of pre-SMA activity and very little is known about the possible lateralization of pre-SMA connectivity. Via functional connectivity analysis, we sought to understand how the language network may be connected to other intrinsic connectivity networks (ICNs) through the pre-SMA. We performed a spatial independent component analysis of resting state functional magnetic resonance imaging in 30 volunteers to identify the language network. Subsequently, we applied seed-to-voxel functional connectivity analyses centered on peaks detected in the pre-SMA. Three signal peaks were detected in the pre-SMA. The left rostral pre-SMA intrinsic connectivity network (LR ICN) was left lateralized in contrast to bilateral ICNs associated to right pre-SMA peaks. The LR ICN was anticorrelated with the dorsal attention network and the right caudal pre-SMA ICN (RC ICN) anticorrelated with the default mode network. These two ICNs overlapped minimally. In contrast, the right rostral ICN overlapped the LR ICN. Both right ICNs overlapped in the ventral attention network (vATT). The bilateral connectivity of the right rostral pre-SMA may allow right hemispheric recruitment to process semantic ambiguities. Overlap between the right pre-SMA ICNs in vATT may contribute to internal thought to external environment reorientation. Distinct ICNs connected to areas involved in lexico-syntactic selection and phonology converge in the pre-SMA, which may constitute the resolution space of competing condition-action associations for speech production.
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Affiliation(s)
- Aram Ter Minassian
- 1 Laboratoire Angevin de Recherche en Ingénierie des Systèmes (LARIS) , Équipe Information, Signal, Image et Sciences du Vivant (ISISV), Université d'Angers, Angers, France
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67
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Voss J, Meier TB, Freidel R, Kundu B, Nair VA, Holdsworth R, Kuo JS, Prabhakaran V. The role of secondary motor and language cortices in morbidity and mortality: a retrospective functional MRI study of surgical planning for patients with intracranial tumors. Neurosurg Focus 2014; 34:E7. [PMID: 23544413 DOI: 10.3171/2013.2.focus12410] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT Functional MRI (fMRI) is commonly used by neurosurgeons preoperatively to identify brain regions associated with essential behaviors, such as language and motor abilities. In this study the authors investigated the relationship between patient morbidity and mortality and the distance from the tumor border area to functional activations in secondary motor and language cortices. METHODS Patients with primary or metastatic brain tumors who underwent preoperative fMRI motor and language mapping were selected from a large database of patients with tumors. The lesion-to-activation distance (LAD) was measured in each patient relative to the supplementary motor area (SMA) for motor tasks and the presupplementary motor area (pSMA) for language tasks. The association between LAD and the incidence of deficits was investigated using the Fisher exact tests of significance. The impact of other variables, including age, handedness, sex, and tumor grade, was also investigated. In a subset of patients, logistic regression was performed to identify the likelihood of deficits based on the LAD to primary and secondary regions. Finally, Mantel-Cox log-rank tests were performed to determine whether survival time was significantly related to the LAD to secondary motor and language areas. RESULTS A significant association was observed between the LAD to the SMA and the incidence of motor deficits, with the percentage of patients with deficits dropping for those in the LAD > 2 cm group. The relationship between the LAD to the pSMA and the incidence of language deficits was not significant. Logistic regression demonstrated that the LAD to primary sensorimotor cortex does affect the incidence of motor deficits, but that the LAD to SMA does not. Finally, the authors observed no relationship between the LAD to secondary regions and patient mortality rates. CONCLUSIONS These results demonstrate that the LAD to SMA structures does affect morbidity, although not to the extent of LAD to primary structures. In addition, motor deficits are significantly associated with LAD to secondary structures, but language deficits are not. This should be considered by neurosurgeons for patient consultation and preoperative planning.
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Affiliation(s)
- Jed Voss
- Departments of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin 53705, USA
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68
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69
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HIROSHIMA S, ANEI R, MURAKAMI N, KAMADA K. Functional Localization of the Supplementary Motor Area. Neurol Med Chir (Tokyo) 2014; 54:511-20. [DOI: 10.2176/nmc.oa2012-0321] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Satoru HIROSHIMA
- Department of Neurosurgery, School of Medicine, Asahikawa Medical University
| | - Ryogo ANEI
- Department of Neurosurgery, School of Medicine, Asahikawa Medical University
| | - Noboru MURAKAMI
- Department of Radiology, School of Medicine, Asahikawa Medical University
| | - Kyousuke KAMADA
- Department of Neurosurgery, School of Medicine, Asahikawa Medical University
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70
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Rech F, Herbet G, Moritz-Gasser S, Duffau H. Disruption of bimanual movement by unilateral subcortical electrostimulation. Hum Brain Mapp 2013; 35:3439-45. [PMID: 24415356 DOI: 10.1002/hbm.22413] [Citation(s) in RCA: 62] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2013] [Revised: 08/28/2013] [Accepted: 09/19/2013] [Indexed: 11/09/2022] Open
Abstract
OBJECTIVES Cortical areas involved in bimanual coordination have been regularly studied by functional neuroimaging and electroencephalography. However, the subcortical connectivity underlying this complex function has received less attention. Here, we used the technique of direct electrostimulation in awake patients who underwent surgery for brain glioma, with the goal to investigate the white matter pathways subserving bimanual coordination. EXPERIMENTAL DESIGN Eight patients were operated under local anesthesia for a frontal low-grade glioma. Intraoperative subcortical electrostimulation mapping was used to search interference with bimanual coordination. The corresponding stimulation sites were reported on brain MRI. PRINCIPAL OBSERVATIONS All patients presented a complete arrest of the movement of both hands during unilateral subcortical stimulation of the white matter underneath the dorsal premotor cortex and the posterior part of the supplementary motor area, rostrally to the corticospinal tract, until the caudate nucleus and the anterior arm of the internal capsule. No movement deficits, especially no disturbances of bimanual coordination, were observed 3 months after surgery. CONCLUSIONS This is the first evidence of bilateral negative motor responses elicited by unilateral subcortical stimulation. Such findings support the existence of a bilateral cortico-subcortical network connecting the premotor cortices, basal ganglia, and spinal cord, involved in the control of bimanual coordination. A better understanding of this modulatory motor circuit may have important implications in fundamental neurosciences as well as in brain surgery.
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Affiliation(s)
- Fabien Rech
- Department of Neurosurgery, CHU Nancy, Nancy University Hospital, France
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71
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Chapados C, Petrides M. Impairment only on the fluency subtest of the Frontal Assessment Battery after prefrontal lesions. Brain 2013; 136:2966-78. [DOI: 10.1093/brain/awt228] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
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72
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Krainik A, Villien M, Troprès I, Attyé A, Lamalle L, Bouvier J, Pietras J, Grand S, Le Bas JF, Warnking J. Functional imaging of cerebral perfusion. Diagn Interv Imaging 2013; 94:1259-78. [PMID: 24011870 DOI: 10.1016/j.diii.2013.08.004] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
The functional imaging of perfusion enables the study of its properties such as the vasoreactivity to circulating gases, the autoregulation and the neurovascular coupling. Downstream from arterial stenosis, this imaging can estimate the vascular reserve and the risk of ischemia in order to adapt the therapeutic strategy. This method reveals the hemodynamic disorders in patients suffering from Alzheimer's disease or with arteriovenous malformations revealed by epilepsy. Functional MRI of the vasoreactivity also helps to better interpret the functional MRI activation in practice and in clinical research.
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Affiliation(s)
- A Krainik
- Clinique universitaire de neuroradiologie et IRM, CHU de Grenoble, CS 10217, 38043 Grenoble cedex, France; Inserm U836, université Joseph-Fourier, site santé, chemin Fortuné-Ferrini, 38706 La Tronche cedex, France; UMS IRMaGe, unité IRM 3T recherche, CHU de Grenoble, CS 10217, 38043 Grenoble cedex 9, France.
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73
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Radman N, Cacioppo S, Spierer L, Schmidlin E, Mayer E, Annoni JM. Posterior SMA Syndrome following subcortical stroke: contralateral akinesia reversed by visual feedback. Neuropsychologia 2013; 51:2605-10. [PMID: 23993907 DOI: 10.1016/j.neuropsychologia.2013.08.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2013] [Revised: 07/09/2013] [Accepted: 08/05/2013] [Indexed: 11/30/2022]
Abstract
BACKGROUND The supplementary motor area (SMA) plays a key role in motor programming and production and is involved in internally-cued movements. In neurological populations, SMA syndrome following a lesion to the "SMA proper" is characterized by transient impairment of voluntary movements and motor sequences. This syndrome is assumed to follow on from an interruption of the motor cortico-subcortical loop, and some case reports indicate that such a syndrome could occur after a brain lesion isolating the SMA from subcortical structures. AIM To characterize the pattern of motor impairments in a patient whose stroke disconnects the SMA from the subcortical motor loop. METHOD A patient developed a moderate transient left hemiparesis following a subcortical stroke in the right anterior cerebral artery area, which disconnected the SMA from basal ganglia. Eight days after the stroke, when the hemiparesis had regressed, the patient presented a specific SMA motor disorder of the left hand which manifested as an akinesia and was exacerbated when his visual attention was not directed towards his hand. We assessed finger tapping with left and right hands, eyes closed and open, in the left and right hemispace. We indexed movement speed as the number of taps filmed over 5-s periods. RESULTS Left motor weakness (grasping strength of right hand: 49 kg and left hand: 41 kg) was resolved in a week. Ideomotor and ideational gestures and motor sequences were preserved. On the tapping task, left-hand tapping was slower than right-hand tapping. Critically, visual feedback improved tapping speed for the left, but not for the right, hand. The hemispace of the task execution had no effect on tapping performance. CONCLUSION Our results suggest that SMA-basal ganglia disconnection decreases contralateral movement initiation and maintenance and this effect is partly compensated by visual cues.
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Affiliation(s)
- Narges Radman
- Neurology Unit, Medicine Department, University of Fribourg, Fribourg 1700, Switzerland.
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74
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Park KM, Kim SE, Shin KJ, Park J, Kim SE, Kim HC, Mun CW, Ha SY. Isolated foot drop in acute infarction of the supplementary motor area. Clin Neurol Neurosurg 2013; 115:2240-2. [PMID: 23911001 DOI: 10.1016/j.clineuro.2013.07.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2013] [Revised: 05/30/2013] [Accepted: 07/06/2013] [Indexed: 11/29/2022]
Affiliation(s)
- Kang Min Park
- Department of Neurology, Haeundae Paik Hospital, Inje University College of Medicine, Busan, Republic of Korea
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75
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Abd-El-Barr MM, Saleh E, Huang RY, Golby AJ. Effect of disease and recovery on functional anatomy in brain tumor patients: insights from functional MRI and diffusion tensor imaging. ACTA ACUST UNITED AC 2013; 5:333-346. [PMID: 24660024 DOI: 10.2217/iim.13.40] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Patients with brain tumors provide a unique opportunity to understand functional brain plasticity. Using advanced imaging techniques, such as functional MRI and diffusion tensor imaging, we have gained tremendous knowledge of brain tumor behavior, transformation, infiltration and destruction of nearby structures. Using these advanced techniques as an adjunct with more proven techniques, such as direct cortical stimulation, intraoperative navigation and advanced microsurgical techniques, we now are able to better formulate safer resection trajectories, perform larger resections at reduced risk and better counsel patients and their families about possible complications. Brain mapping in patients with brain tumors and other lesions has shown us that the old idea of fixed function of the adult cerebral cortex is not entirely true. Improving care for patients with brain lesions in the future will depend on better understanding of the functional organization and plasticity of the adult brain. Advanced noninvasive brain imaging will undoubtedly play a role in advancing this understanding.
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Affiliation(s)
- Muhammad M Abd-El-Barr
- Department of Neurosurgery, Brigham & Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA
| | - Emam Saleh
- Department of Neurosurgery, Brigham & Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA
| | - Raymond Y Huang
- Department of Radiology, Brigham & Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA
| | - Alexandra J Golby
- Department of Neurosurgery, Brigham & Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA ; Department of Radiology, Brigham & Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA
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76
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Duffau H, Mandonnet E. The "onco-functional balance" in surgery for diffuse low-grade glioma: integrating the extent of resection with quality of life. Acta Neurochir (Wien) 2013; 155:951-7. [PMID: 23447053 DOI: 10.1007/s00701-013-1653-9] [Citation(s) in RCA: 144] [Impact Index Per Article: 13.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2013] [Accepted: 02/08/2013] [Indexed: 12/25/2022]
Abstract
Diffuse low-grade glioma (DLGG) is a growing pre-cancerous tumor, often diagnosed in patients with no or only mild deficit. Maximal and early surgical resection is currently the first therapeutic option, in order to delay the malignant transformation and thus increase the overall survival. Preserving the quality of life (QoL) is nonetheless another priority. Here, our purpose is to weight the value of the extent of resection versus the neurological worsening that could be voluntarily generated by a radical resection; that is, to study the "onco-functional balance" at the individual level. To this end, we will examine DLGG involving the supplementary motor area and DLGG involving visual pathways. We will consider the benefit-risk ratio of different strategies of resection, according to the brain structures actually invaded and their plastic potential. The aim is to increase both the quantity of life and the time with a normal QoL, on the basis of strong interactions between the tumor course, brain reorganization and multistage surgical approach adapted to each patient over time. To this end, beyond the conceptual and technical issues, the most important point remains the honest and unique relationship between the surgical oncologist and the patient, based on clear and complete information about the behavior of DLGG versus the expected medical and social consequences of a resection over years. In other words, in the era of "evidence-based medicine", it is crucial to not forget "individual-based medicine" by offering tailored resections adapted to each patient.
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77
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Barbaro NM. Supplementary motor resections. J Neurosurg 2013; 119:4. [PMID: 23641827 DOI: 10.3171/2013.1.jns121986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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78
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Chen S, Entakli J, Bonnard M, Berton E, De Graaf JB. Functional corticospinal projections from human supplementary motor area revealed by corticomuscular coherence during precise grip force control. PLoS One 2013; 8:e60291. [PMID: 23555945 PMCID: PMC3605387 DOI: 10.1371/journal.pone.0060291] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2012] [Accepted: 02/26/2013] [Indexed: 11/19/2022] Open
Abstract
The purpose of the present study was to investigate whether corticospinal projections from human supplementary motor area (SMA) are functional during precise force control with the precision grip (thumb-index opposition). Since beta band corticomuscular coherence (CMC) is well-accepted to reflect efferent corticospinal transmission, we analyzed the beta band CMC obtained with simultaneous recording of electroencephalographic (EEG) and electromyographic (EMG) signals. Subjects performed a bimanual precise visuomotor force tracking task by applying isometric low grip forces with their right hand precision grip on a custom device with strain gauges. Concurrently, they held the device with their left hand precision grip, producing similar grip forces but without any precision constraints, to relieve the right hand. Some subjects also participated in a unimanual control condition in which they performed the task with only the right hand precision grip while the device was held by a mechanical grip. We analyzed whole scalp topographies of beta band CMC between 64 EEG channels and 4 EMG intrinsic hand muscles, 2 for each hand. To compare the different topographies, we performed non-parametric statistical tests based on spatio-spectral clustering. For the right hand, we obtained significant beta band CMC over the contralateral M1 region as well as over the SMA region during static force contraction periods. For the left hand, however, beta band CMC was only found over the contralateral M1. By comparing unimanual and bimanual conditions for right hand muscles, no significant difference was found on beta band CMC over M1 and SMA. We conclude that the beta band CMC found over SMA for right hand muscles results from the precision constraints and not from the bimanual aspect of the task. The result of the present study strongly suggests that the corticospinal projections from human SMA become functional when high precision force control is required.
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Affiliation(s)
- Sophie Chen
- Aix-Marseille Université, CNRS, ISM UMR 7287, 13288, Marseille, France
- Aix-Marseille Université, INSERM, INS UMR_S 1106, 13385, Marseille, France
| | - Jonathan Entakli
- Aix-Marseille Université, CNRS, ISM UMR 7287, 13288, Marseille, France
| | - Mireille Bonnard
- Aix-Marseille Université, INSERM, INS UMR_S 1106, 13385, Marseille, France
| | - Eric Berton
- Aix-Marseille Université, CNRS, ISM UMR 7287, 13288, Marseille, France
| | - Jozina B. De Graaf
- Aix-Marseille Université, CNRS, ISM UMR 7287, 13288, Marseille, France
- * E-mail:
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Florman JE, Duffau H, Rughani AI. Lower motor neuron findings after upper motor neuron injury: insights from postoperative supplementary motor area syndrome. Front Hum Neurosci 2013; 7:85. [PMID: 23508473 PMCID: PMC3600571 DOI: 10.3389/fnhum.2013.00085] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2012] [Accepted: 03/01/2013] [Indexed: 02/01/2023] Open
Abstract
Hypertonia and hyperreflexia are classically described responses to upper motor neuron injury. However, acute hypotonia and areflexia with motor deficit are hallmark findings after many central nervous system insults such as acute stroke and spinal shock. Historic theories to explain these contradictory findings have implicated a number of potential mechanisms mostly relying on the loss of descending corticospinal input as the underlying etiology. Unfortunately, these simple descriptions consistently fail to adequately explain the pathophysiology and connectivity leading to acute hyporeflexia and delayed hyperreflexia that result from such insult. This article highlights the common observation of acute hyporeflexia after central nervous system insults and explores the underlying anatomy and physiology. Further, evidence for the underlying connectivity is presented and implicates the dominant role of supraspinal inhibitory influence originating in the supplementary motor area descending through the corticospinal tracts. Unlike traditional explanations, this theory more adequately explains the findings of postoperative supplementary motor area syndrome in which hyporeflexia motor deficit is observed acutely in the face of intact primary motor cortex connections to the spinal cord. Further, the proposed connectivity can be generalized to help explain other insults including stroke, atonic seizures, and spinal shock.
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Martino J, de Lucas EM, Ibáñez-Plágaro FJ, Valle-Folgueral JM, Vázquez-Barquero A. Foix-Chavany-Marie syndrome caused by a disconnection between the right pars opercularis of the inferior frontal gyrus and the supplementary motor area. J Neurosurg 2012; 117:844-50. [DOI: 10.3171/2012.7.jns12404] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Foix-Chavany-Marie syndrome (FCMS) is a rare type of suprabulbar palsy characterized by an automaticvoluntary dissociation of the orofacial musculature. Here, the authors report an original case of FCMS that occurred intraoperatively while resecting the pars opercularis of the inferior frontal gyrus.
This 25-year-old right-handed man with an incidentally diagnosed right frontotemporoinsular tumor underwent surgery using an asleep-awake-asleep technique with direct cortical and subcortical electrical stimulation and a transopercular approach to the insula. While resecting the anterior part of the pars opercularis the patient suffered sudden anarthria and bilateral facial weakness. He was unable to speak or show his teeth on command, but he was able to voluntarily move his upper and lower limbs. This syndrome lasted for 8 days. Postoperative diffusion tensor imaging tractography revealed that connections of the pars opercularis of the right inferior frontal gyrus with the frontal aslant tract (FAT) and arcuate fasciculus (AF) were damaged.
This case supplies evidence for localizing the structural substrate of FCMS. It was possible, for the first time in the literature, to accurately correlate the occurrence of FCMS to the resection of connections between the FAT and AF, and the right pars opercularis of the inferior frontal gyrus. The FAT has been recently described, but it may be an important connection to mediate supplementary motor area control of orofacial movement. The present case also contributes to our knowledge of complication avoidance in operculoinsular surgery. A transopercular approach to insuloopercular gliomas can generate FCMS, especially in cases of previous contralateral lesions. The prognosis is favorable, but the patient should be informed of this particular hazard, and the surgeon should anticipate the surgical strategy in case the syndrome occurs intraoperatively in an awake patient.
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Affiliation(s)
| | - Enrique Marco de Lucas
- 2Radiology, Hospital Universitario Marqués de Valdecilla and Instituto de Formación e Investigación Marqués de Valdecilla, Santander, Cantabria; and
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Kasasbeh AS, Yarbrough CK, Limbrick DD, Steger-May K, Leach JL, Mangano FT, Smyth MD. Characterization of the supplementary motor area syndrome and seizure outcome after medial frontal lobe resections in pediatric epilepsy surgery. Neurosurgery 2012; 70:1152-68; discussion 1168. [PMID: 22067422 DOI: 10.1227/neu.0b013e31823f6001] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND In adults, resection of the medial frontal lobe has been shown to result in supplementary motor area (SMA) syndrome, a disorder characterized by transient motor impairment. Studies examining the development of SMA syndrome in children, however, are wanting. OBJECTIVE To characterize the development of SMA syndrome and to analyze seizure outcomes after surgery in the medial frontal lobe for medically intractable epilepsy. METHODS Thirty-nine patients with medically intractable epilepsy who underwent surgery in the medial frontal lobe were reviewed retrospectively. The progression of neurological impairment and seizure outcome after surgery was recorded, and the extent of cortex resected was analyzed. RESULTS After resection in the region of the SMA, 23 patients (59%) developed postoperative neurological impairment; 17 (74%) were identified as SMA syndrome. No neurological impairment was found after surgery in 16 patients (41%). Six patients (15%) experienced permanent neurological impairment. The majority of patients (82%) who developed SMA syndrome had resolution of their symptoms by 1 month postoperatively. Preoperative magnetic resonance imaging finding of lesional cases was associated with a significantly decreased likelihood of developing SMA syndrome (P = .02). Seizure outcome was favorable after surgery in most patients. CONCLUSION Surgery for medically intractable epilepsy in the region of the medial frontal cortex is effective and associated with reversible neurological impairment in children. All patients had resolution of their SMA syndrome by 6 months postoperatively.
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Affiliation(s)
- Aimen S Kasasbeh
- Department of Neuroscience, University of Arizona, Tucson, Arizona 85719, USA.
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Bryszewski B, Pfajfer L, Antosik-Biernacka A, Tybor K, Smigielski J, Zawirski M, Majos A. Functional rearrangement of the primary and secondary motor cortex in patients with primary tumors of the central nervous system located in the region of the central sulcus depending on the histopathological type and the size of tumor: Examination by means of functional magnetic resonance imaging. Pol J Radiol 2012; 77:12-20. [PMID: 22802861 PMCID: PMC3389955 DOI: 10.12659/pjr.882576] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2011] [Accepted: 01/19/2012] [Indexed: 11/23/2022] Open
Abstract
Background: The aim of this study was to analyze the reorganization of the centers of the motor cortex in patients with primary neuroepithelial tumors of the central nervous system (CNS) located in the region of the central sulcus in relation to the histopathological type and the size of tumor, as determined by means of functional magnetic resonance imaging (fMRI). Material/Methods: The fMRI was performed prior to the surgical treatment of patients with tumors located in the region of the central sulcus (WHO stage I and II, n=15; WHO stage III and IV, n=25). The analysis included a record of the activity in the areas of the primary motor cortex (M1) and the secondary motor cortex: the premotor cortex (PMA) and the accessory motor area (SMA). The results were correlated with the histopathological type of the tumor and its size expressed in cm3. Results: The frequency of activation of the motor center was higher in the group of patients who had less aggressive tumors, such as low-grade glioma (LGG), as well as in tumors of lower volume, and this was true both for the hemisphere where the tumor was located and in the contralateral one. Mean values of t-statistics of activation intensity, mean numbers of activated clusters, and their ranges were lower in all analyzed motor areas of LGG tumors. The values of t-statistics and activation areas were higher in the case of small tumors located in ipsilateral centers, and in large tumors located in contralateral centers, aside from the SMA area where the values of t-statistics were equal for both groups. The contralateral SMA area was characterized by the highest stability of all examined centers of secondary motor cortex. No significant association (p>0.05) was observed between the absolute value of the mean registered activity (t-statistics) and the size of examined areas (number of clusters) when the groups were stratified with regards to the analyzed parameters. Conclusions: The presence of a neoplastic lesion, its histopathological type and finally its size modulate the functional reorganization of the motor centers as suggested by the differences in the frequency of the neural center activation in the analyzed groups. Processes of functional rearrangement are more pronounced and more precisely defined in patients with less aggressive and/or smaller tumors. The contralateral accessory area is the most frequently activated center in all analyzed groups irrespective of the grade and size of the tumor.
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Affiliation(s)
- Bartosz Bryszewski
- Department of Neurosurgery, Medical University of Łódź, Barlicki University Hospital No.1, Łódź, Poland
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Schucht P, Moritz-Gasser S, Herbet G, Raabe A, Duffau H. Subcortical electrostimulation to identify network subserving motor control. Hum Brain Mapp 2012; 34:3023-30. [PMID: 22711688 DOI: 10.1002/hbm.22122] [Citation(s) in RCA: 89] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2011] [Revised: 04/04/2012] [Accepted: 04/16/2012] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES Recent anatomical-functional studies have transformed our understanding of cerebral motor control away from a hierarchical structure and toward parallel and interconnected specialized circuits. Subcortical electrical stimulation during awake surgery provides a unique opportunity to identify white matter tracts involved in motor control. For the first time, this study reports the findings on motor modulatory responses evoked by subcortical stimulation and investigates the cortico-subcortical connectivity of cerebral motor control. EXPERIMENTAL DESIGN Twenty-one selected patients were operated while awake for frontal, insular, and parietal diffuse low-grade gliomas. Subcortical electrostimulation mapping was used to search for interference with voluntary movements. The corresponding stimulation sites were localized on brain schemas using the anterior and posterior commissures method. PRINCIPAL OBSERVATIONS Subcortical negative motor responses were evoked in 20/21 patients, whereas acceleration of voluntary movements and positive motor responses were observed in three and five patients, respectively. The majority of the stimulation sites were detected rostral of the corticospinal tract near the vertical anterior-commissural line, and additional sites were seen in the frontal and parietal white matter. CONCLUSIONS The diverse interferences with motor function resulting in inhibition and acceleration imply a modulatory influence of the detected fiber network. The subcortical stimulation sites were distributed veil-like, anterior to the primary motor fibers, suggesting descending pathways originating from premotor areas known for negative motor response characteristics. Further stimulation sites in the parietal white matter as well as in the anterior arm of the internal capsule indicate a large-scale fronto-parietal motor control network.
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Affiliation(s)
- Philippe Schucht
- Department of Neurosurgery, Bern University Hospital, Bern, Switzerland
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84
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De Benedictis A, Duffau H. Brain Hodotopy: From Esoteric Concept to Practical Surgical Applications. Neurosurgery 2011; 68:1709-23; discussion 1723. [DOI: 10.1227/neu.0b013e3182124690] [Citation(s) in RCA: 146] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
AbstractBACKGROUND:The traditional neurosurgical approach to cerebral lesions is based on the classic view of a rigid brain organization in fixed “eloquent” areas. However, this method is brought into discussion by the conceptual and methodological advances in neurosciences that provide a more dynamic representation of the anatomo-functional distribution of the human central nervous system (CNS).OBJECTIVE AND METHODS:We review the relevant literature concerning the main features of the modern CNS representation and their implications in neurosurgical practice.RESULTS:The CNS is an integrated, wide, plastic network made up of cortical functional epicenters, “topic organization,” connected by both short-local and large-scale white matter fibers, ie, “hodological organization.” According to this model, called hodotopic, brain function results from parallel streams of information dynamically modulated within an interactive, multimodal, and widely distributed circuit. The application of this framework, which can be studied by combining preoperative, intraoperative, and postoperative mapping techniques, enables the neurosurgeon exploration of the individual anatomo-functional architecture, including neurocognitive and emotional aspects. Thus, it is possible to adapt the surgical approach specifically to each patient and to each lesion according to the individual organization. Several experiences demonstrate the possibility of removing regions traditionally considered inoperable without inducing permanent deficits and the potential use of these areas as a safe passage to deeper territories.CONCLUSION:We advocate the more systematic integration of a hodotopical view of the CNS to improve the surgical indications and planning for brain lesions, with the goal of optimizing both the extent of resection and functional outcome.
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Affiliation(s)
| | - Hugues Duffau
- Department of Neurosurgery, Hôpital Gui de Chauliac, CHU Montpellier, Montpellier, France
- Institute of Neuroscience of Montpellier, INSERM U1051, Plasticity of Central Nervous System, Human Stem Cells and Glial Tumors, Hôpital Saint Eloi, CHU Montpellier, Montpellier, France
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85
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Schwenzer M, Mathiak K. Numeric aspects in pitch identification: an fMRI study. BMC Neurosci 2011; 12:26. [PMID: 21392373 PMCID: PMC3062602 DOI: 10.1186/1471-2202-12-26] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2010] [Accepted: 03/09/2011] [Indexed: 11/14/2022] Open
Abstract
Background Pitch identification had yielded unique response patterns compared to other auditory skills. Selecting one out of numerous pitches distinguished this task from detecting a pitch ascent. Encoding of numerous stimuli had activated the intraparietal sulcus in the visual domain. Therefore, we hypothesized that numerosity encoding during pitch identification activates the intraparietal sulcus as well. Methods To assess pitch identification, the participants had to recognize a single pitch from a set of four possible pitches in each trial. Functional magnetic resonance imaging (fMRI) disentangled neural activation during this four-pitch-choice task from activation during pitch contour perception, tone localization, and pitch discrimination. Results Pitch identification induced bilateral activation in the intraparietal sulcus compared to pitch discrimination. Correct responses in pitch identification correlated with activation in the left intraparietal sulcus. Pitch contour perception activated the superior temporal gyrus conceivably due to the larger range of presented tones. The differentiation between pitch identification and tone localization failed. Activation in an ACC-hippocampus network distinguished pitch discrimination from pitch identification. Conclusion Pitch identification is distinguishable from pitch discrimination on the base of activation in the IPS. IPS activity during pitch identification may be the auditory counterpart of numerosity encoding in the visual domain.
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Affiliation(s)
- Michael Schwenzer
- Department of Psychiatry, Psychotherapy and Psychosomatics, RWTH Aachen University, Aachen, Germany.
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86
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Intrasurgical mapping of complex motor function in the superior frontal gyrus. Neuroscience 2011; 179:131-42. [PMID: 21277357 DOI: 10.1016/j.neuroscience.2011.01.047] [Citation(s) in RCA: 63] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2010] [Revised: 01/21/2011] [Accepted: 01/23/2011] [Indexed: 11/22/2022]
Abstract
A lesion to the superior frontal gyrus (SFG) has been associated with long-lasting deficits in complex motor functions. The aim of this study was to analyze the functional role of the SFG by means of electrical cortical stimulation. Direct intraoperative electrical stimulation was used in a group of 21 subjects with lesions within or close to the SFG while they performed three motor tasks that require high skills or bimanual synergy. The results were compared to functional magnetic resonance imaging (fMRI). Ninety-four of the 98 (94.9%) labels identified were located on the convexity surface of the SFG and only four (4.1%) labels were located on the middle surface of the SFG. Areas of blockage of the three tasks were identified in six of the 12 (50%) hemispheres with lesions that had infiltrated the SFG, compared to all 10 of the 10 hemispheres (100%) with lesions that spared the SFG. The difference between these two proportions was statistically significant (P=0.015). fMRI activation was mainly located on the medial aspect of the SFG. We show that the convexity surface of the SFG has an important role in bilateral control of complex movements and in bimanual coordination. The infiltration of the posterior part of the SFG by a lesion disturbs some of the complex hand motor functions, which may be assumed by the contralesional homologous area. Finally, the current study emphasizes the discrepancies between fMRI and intraoperative electrical stimulation maps in complex hand motor function.
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87
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Identificación intraoperatoria del área motora suplementaria en cirugía neurooncológica. Neurocirugia (Astur) 2011. [DOI: 10.1016/s1130-1473(11)70010-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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88
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Vaalto S, Säisänen L, Könönen M, Julkunen P, Hukkanen T, Määttä S, Karhu J. Corticospinal output and cortical excitation-inhibition balance in distal hand muscle representations in nonprimary motor area. Hum Brain Mapp 2010; 32:1692-703. [PMID: 20886574 DOI: 10.1002/hbm.21137] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2010] [Revised: 06/24/2010] [Accepted: 07/06/2010] [Indexed: 11/06/2022] Open
Abstract
Transcranial magnetic stimulation (TMS) of the superior frontal gyrus in the non-primary motor area (NPMA) can evoke motor-evoked potentials (MEPs) at 20 ms latency range in contralateral distal hand muscles similar to stimulation of M1 and indicating monosynaptic corticospinal tracts. We compared the intracortical inhibitory and excitatory balance in primary motor cortex (M1) and in NPMA by navigated single- and paired-pulse TMS (ppTMS). We also evaluated the spatial stability of muscle representations in M1 and NPMA by remapping 11 healthy subjects one year after the initial mapping. Resting motor threshold (rMT) was higher in NPMA than in M1 as were the MEP amplitudes evoked by 120% rMT stimulation intensity of the local MT. Short-interval intracortical inhibition (SICI) was significantly weaker in NPMA than in M1 at ISI of 2 ms and conditioning stimulus (CS) 80% rMT. Our findings suggest that the cortical hand representations in NPMA 1) are connected to lower motoneurons monosynaptically, 2) are less strictly organized, i.e. motoneuron population representing a discrete hand muscle is sparser and less dense than in M1 and 3) have the capacity to generate powerful, rapid muscle contraction if sufficient number of motoneurones are activated. In NPMA, local intracortical inhibitory and excitatory activity is mainly similar to that in M1. The lower SICI in NPMA at an ISI of 2 ms may reflect less strict topographic organization and readiness to reorganization of neural circuits during motor learning or after motor deficits.
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Affiliation(s)
- Selja Vaalto
- Department of Clinical Neurophysiology, University of Eastern Finland, Kuopio, Finland.
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89
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Wada Y, Nishimura Y. Isolated astasia in acute infarction of the supplementary-motor area. BMJ Case Rep 2010; 2010:2010/aug06_1/bcr0120102618. [PMID: 22767673 DOI: 10.1136/bcr.01.2010.2618] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Astasia, which is the inability to stand in the absence of motor weakness or marked sensory loss, is an uncommon clinical feature of stroke in the thalamic ventrolateral region. The authors describe a patient with a unilateral supplementary motor area (SMA) infarction presenting with contralateral astasia. On neurological examination, he would lean to the left side and would fall unless supported. He showed no muscle weakness, sensory deficits or cerebellar ataxia. Magnetic resolution imaging of the brain showed acute infarction only involving the right SMA. On the basis of the anatomy that the SMA is connected to the vestibulocerebellar system through the ventrolateral nucleus of the thalamus, the authors concluded that contralateral astasia probably resulted from disruption of this connection following infarction of the SMA.
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Affiliation(s)
- Yuko Wada
- Department of Neurology, Nishi-Kobe Medical Center, Kobe, Japan.
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90
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Rosenberg K, Nossek E, Liebling R, Fried I, Shapira-Lichter I, Hendler T, Ram Z. Prediction of neurological deficits and recovery after surgery in the supplementary motor area: a prospective study in 26 patients. J Neurosurg 2010; 113:1152-63. [PMID: 20635854 DOI: 10.3171/2010.6.jns1090] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT Resection of lesions involving the supplementary motor area (SMA) may result in immediate postoperative motor and speech deficits that are reversible in most cases. In the present study the authors aimed to determine the critical involvement of SMA in the lesioned and healthy hemispheres in this functional recovery. They hypothesized that compensatory mechanisms take place following surgery in the SMA, and that these mechanisms can involve either the lesioned or the non-lesioned hemisphere. In addition, they hypothesized that a correlation will be present between the functional MR imaging (fMR) imaging-related activation in the SMA and the occurrence of a functional deficit during intraoperative cortical stimulation. METHODS Twenty-six patients scheduled for resection of space-occupying lesions involving, or in the vicinity of, the SMA were recruited. Patients underwent an fMR imaging examination that included finger-tapping and verb-generation tests to assess for motor and language functions. Intraoperatively direct cortical stimulation (DCS) of the SMA region was performed while patients were monitored for language and motor functions using tests similar to those used for the fMR imaging. Task dysfunction during DCS assessed the critical involvement of the SMA in the tested functions. Neurological evaluations were performed prior to surgery and at 3 time points within a month following surgery. A region of interest-based approach was used to evaluate fMR imaging blood oxygen level-dependent activation level and asymmetry in the SMA. These measurements were later compared with the intraoperative DCS and neurological findings. RESULTS Functional MR imaging showed greater activation and dominance of the SMA in the lesioned hemisphere in patients who exhibited no motor or language dysfunction during DCS. In addition, patients with the highest activation of the SMA in the lesioned hemisphere for language and motor tests showed stronger coupling of this region with ipsilateral motor and language networks. In contrast, activation in the nonlesioned hemisphere did not correspond with DCS results. CONCLUSIONS The authors' findings demonstrate the necessity of activation in the vicinity of the lesioned SMA for functional compensation in motor and language tasks. It is possible that more effective functional coupling of the SMA with motor and language areas in the same hemisphere prevents dysfunctions following surgical intervention. Importantly, fMR imaging activation in the unaffected SMA was not sufficient for development of functional compensation and, if anything, indicated decompensation.
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Affiliation(s)
- Keren Rosenberg
- Whole Institute for Advanced Imaging, Department of Neurosurgery, Epilepsy and Functional Neurosurgery Unit, Tel Aviv Medical Center, Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
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91
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Tao Y, Guojun Z, Yuping W, Lixin C, Wei D, Yongjie L. Surgical treatment of patients with drug-resistant hypermotor seizures. Epilepsia 2010; 51:2124-30. [DOI: 10.1111/j.1528-1167.2010.02590.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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92
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Abstract
OBJECTIVE During the past decade, numerous reports have supported the contribution of awake mapping in surgical removal of brain lesions in eloquent areas, with a significant increase of the extent of resection while minimizing the risk of permanent deficit--and even improving quality of life. METHODS Most of these awake procedures were performed in patients with lesions in language areas, to avoid postoperative aphasia. Surprisingly, mapping of nonlanguage functions received less attention, despite the possible consequences of deficits other than aphasia on daily life. Visuospatial and cognitive deficits are reported after brain surgery, because of more objective and extensive neuropsychological assessments. RESULTS AND CONCLUSION This review provides new insights into the indications of awake craniotomies for nonlanguage mapping in surgery for lesions in areas not related to language processing.
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Affiliation(s)
- Hugues Duffau
- Department of Neurosurgery, Hôpital Gui de Chauliac, CHU Montpellier, Montpellier, France.
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93
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Berdyyeva TK, Olson CR. Rank signals in four areas of macaque frontal cortex during selection of actions and objects in serial order. J Neurophysiol 2010; 104:141-59. [PMID: 20445037 DOI: 10.1152/jn.00639.2009] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Neurons in several areas of monkey frontal cortex exhibit ordinal position (rank) selectivity during the performance of serial order tasks. It has been unclear whether rank selectivity or the dependence of rank selectivity on task context varies across the areas of frontal cortex. To resolve this issue, we recorded from neurons in the supplementary motor area (SMA), presupplementary motor area (pre-SMA), supplementary eye field (SEF), and dorsolateral prefrontal cortex (dlPFC) as monkeys performed two oculomotor tasks, one requiring the selection of three actions in sequence and the other requiring the selection of three objects in sequence. We found that neurons representing all ranks were present in all areas. Only to a moderate degree did the prevalence and nature of rank selectivity vary from area to area. The two most prominent inter-area differences involved a lower prevalence of rank selectivity in the dlPFC than in the other areas and a higher proportion of neurons preferring late ranks in the SMA and SEF than in the other areas. Neurons in all four areas are rank generalists in the sense of favoring the same rank in both the serial action task and the serial object task.
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Affiliation(s)
- Tamara K Berdyyeva
- Center for the Neural Basis of Cognition, Mellon Institute, Carnegie Mellon University, Pittsburgh, Pennsylvania, USA.
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de Oliveira-Souza R, Moll J. The neural bases of normal and deviant moral cognition and behavior. Top Magn Reson Imaging 2009; 20:261-270. [PMID: 20859187 DOI: 10.1097/rmr.0b013e3181f22f69] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Affiliation(s)
- Ricardo de Oliveira-Souza
- Cognitive and Behavioral Neuroscience Unit, D'Or Institute for Research and Education (IDOR), Rio de Janeiro, RJ, Brazil
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95
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Joint activation of the supplementary motor area and presupplementary motor area during simultaneous motor and language functional MRI. Neuroreport 2009; 20:487-91. [DOI: 10.1097/wnr.0b013e3283297d71] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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96
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Abstract
The supplementary motor complex consists of the supplementary motor area, the supplementary eye field and the pre-supplementary motor area. In recent years, these areas have come under increasing scrutiny from cognitive neuroscientists, motor physiologists and clinicians because they seem to be crucial for linking cognition to action. However, theories regarding their function vary widely. This Review brings together the data regarding the supplementary motor regions, highlighting outstanding issues and providing new perspectives for understanding their functions.
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97
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Sanchez A, Stuth EAE, Lew SM. Postoperative upper extremity hemiplegia in a toddler following general anesthesia for drainage of a subgaleal fluid collection. Paediatr Anaesth 2008; 18:564-6. [PMID: 18445208 DOI: 10.1111/j.1460-9592.2008.02464.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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98
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Amiez C, Kostopoulos P, Champod AS, Collins DL, Doyon J, Del Maestro R, Petrides M. Preoperative functional magnetic resonance imaging assessment of higher-order cognitive function in patients undergoing surgery for brain tumors. J Neurosurg 2008; 108:258-68. [PMID: 18240920 DOI: 10.3171/jns/2008/108/2/0258] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT Resection of brain tumors has been shown to increase patient survival. The extent of the possible resection, however, depends on whether the tumor has invaded brain regions important for motor, sensory, or cognitive processes and whether the brain tissue surrounding the tumor maintains its functional role. The goal of the present study was to develop new pre- and intraoperative tools to specifically assess the function of the rostral part of the dorsal premotor cortex (PMdr) in 4 patients with brain tumors close to this region. METHODS Using functional magnetic resonance (fMR) imaging and a task developed to assess accurate selection between competing responses based on conditional rules, the authors preoperatively assessed the function of the PMdr in 4 patients with brain tumors close to this region. In 1 patient, the authors developed an intraoperative procedure to assess performance on the task during the tumor resection. RESULTS Preoperative fMR imaging data showed specific activity increases in the vicinity of the tumors, that is, in the PMdr. As confirmed by postoperative structural MR imaging, the extent of the tumor resection was optimal and the functional region within the PMdr was preserved. Furthermore, patients exhibited no postoperative deficits during task performance, demonstrating that the function was preserved. Intraoperative behavioral results demonstrated that the cognitive processes underlying performance on the task remained intact throughout the tumor resection. CONCLUSIONS These findings suggest that preoperative fMR imaging, together with intraoperative behavioral evaluation, may be a useful paradigm to assist neurosurgeons in preserving cognitive function in patients with brain tumors.
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Affiliation(s)
- Céline Amiez
- Neuropsychology/Cognitive Neuroscience Unit, Brain Imaging Centre, Montreal Neurological Institute, Department of Neurology and Neurosurgery, McGill University, Montréal, Quebec, Canada.
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Chen XK, Xiao YY, Zheng WB, Chen FY, Wu RH. Functional magnetic resonance mapping of motor cortex in patients with mass lesions near primary motor and sensory cortices. CONFERENCE PROCEEDINGS : ... ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL CONFERENCE 2008; 2006:1877-80. [PMID: 17946484 DOI: 10.1109/iembs.2006.260598] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
PURPOSE To study motor cortex mapping in patients with mass lesions near primary motor and sensory cortices with BOLD-fMRI. MATERIAL AND METHODS 18 patients with mass lesions near primary motor and sensory cortices, and 8 healthy volunteers were investigated with fMRI using a 1.5 T GE Signa scanner. The specific task was repetitive selfpaced index finger to thumb opposition with a frequency of approximately 2 Hz. Each task paradigm consisted of twelve 20-second blocks alternating between rest and activation. All functional data was sent to SUN GE Advanced Workstation 4.0 for post processing. RESULTS 14 patients showed functional activation near mass lesion, 4 patients failed to show, and one patient with meningeoma was excluded because of heavy head movement. Of 14 patients, the functional activation of eloquent cortex was different between the group with declination of muscle force and the group with normal muscle force, generally the activated areas of the former were more scattered, dislocated, relative smaller than that of the latter. CONCLUSION fMRI is a valuable method for pre-operative evaluation of neurosurgical patients and probably can evaluate the muscle force pre- and post-operation approximately.
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Affiliation(s)
- X K Chen
- Dept. of Med. Imaging, Shantou Univ, China.
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Fall S, de Marco G. Assessment of brain interactivity in the motor cortex from the concept of functional connectivity and spectral analysis of fMRI data. BIOLOGICAL CYBERNETICS 2008; 98:101-114. [PMID: 18057954 DOI: 10.1007/s00422-007-0198-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/23/2007] [Accepted: 10/12/2007] [Indexed: 05/25/2023]
Abstract
Functional magnetic resonance imaging (fMRI) was used to assess the contributions of movement preparation and execution of a visuomotor task in a cerebral motor network. The functional connectivity of the voxel time series between brain regions in the frequency space was investigated by performing spectral analysis of fMRI time series. The regional interactivities between the two portions of the supplementary motor area (pre-SMA and SMA-proper) and the primary motor cortex (M1), defined as a seed region, were evaluated. The spectral parameter of coherence was used to describe a correlation structure in the frequency domain between two voxel-based time series and to infer the strength of the functional interaction within our presumed motor network of connections. The results showed meaningful differences of the functional interactions between the two portions of the SMA and the M1 area depending on the task conditions. This approach demonstrated the existence of a functional dissociation between the pre-SMA and SMA-proper subregions. We therefore conclude that spectral analysis is useful for identifying functional interactions of brain regions and might provide a powerful tool to quantify changes in connectivity profiles associated with various components of an experimental task.
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Affiliation(s)
- S Fall
- Laboratoire de Biophysique et Traitement de l'Image Médicale, CHU-nord UPJV Amiens, Amiens Cedex, France.
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