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The supplementary motor area syndrome: a neurosurgical review

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Abstract

The supplementary motor area (SMA) syndrome is a frequently encountered clinical phenomenon associated with surgery of the dorsomedial prefrontal lobe. The region has a known motor sequencing function and the dominant pre-SMA specifically is associated with more complex language functions; the SMA is furthermore incorporated in the negative motor network. The SMA has a rich interconnectivity with other cortical regions and subcortical structures using the frontal aslant tract (FAT) and the frontostriatal tract (FST). The development of the SMA syndrome is positively correlated with the extent of resection of the SMA region, especially its medial side. This may be due to interruption of the nearby callosal association fibres as the contralateral SMA has a particular important function in brain plasticity after SMA surgery. The syndrome is characterized by a profound decrease in interhemispheric connectivity of the motor network hubs. Clinical improvement is related to increasing connectivity between the contralateral SMA region and the ipsilateral motor hubs. Overall, most patients know a full recovery of the SMA syndrome, however a minority of patients might continue to suffer from mild motor and speech dysfunction. Rarely, no recovery of neurological function after SMA region resection is reported.

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Authors and Affiliations

  1. Department of Neurosurgery, AZ Delta, Roeselare, Belgium

    Harry Pinson, Jeroen Van Lerbeirghe, Dimitri Vanhauwaert & Olivier Van Damme

  2. Department of Neurosurgery, Ghent University Hospital, C. Heymanslaan 10, 9000, Ghent, Belgium

    Harry Pinson, Giorgio Hallaert & Jean-Pierre Kalala

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Appendix

Appendix

Search string used in PubMed:

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    Humans

  2. 2.

    Brain Neoplasms/surgery

  3. 3.

    Glioma/surgery

  4. 4.

    Motor cortex/surgery

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    Prefrontal Cortex/surgery

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    Brain Mapping

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    Electric Stimulation

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    2 or 3 or 4 or 5 or 6 or 7

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    1 and 8

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    Neurosurgical Procedures/adverse effects

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    Postoperative Complications

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    Recovery of Function/physiology

  13. 13.

    Speech

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    Speech disorders

  15. 15.

    Mutism

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    Motor Skills Disorders

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    Movement

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    Paresis

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    Sensation

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    Psychomotor Performance.

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    10 or 11 or 12 or 13 or 14 or 15 or 16 or 17 or 18 or 19 or 20

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    Human

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    Neurosurgery

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    Motor Cortex

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    Electrostimulation

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    2 or 3 or 4 or 5

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    1 and 6

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    Neurological Complication

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    Postoperative Complication

  10. 10.

    Functional Connectivity

  11. 11.

    Motor Dysfunction

  12. 12.

    Motor Performance

  13. 13.

    Paralysis

  14. 14.

    Supplementary Motor Area Syndrome

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    Speech Disorder

  16. 16.

    Speech

  17. 17.

    Language

  18. 18.

    Functional Status.

  19. 19.

    8 or 9 or 10 or 11 or 12 or 13 or 14 or 15 or 16 or 17 or 18

  20. 20.

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Pinson, H., Van Lerbeirghe, J., Vanhauwaert, D. et al. The supplementary motor area syndrome: a neurosurgical review. Neurosurg Rev 45, 81–90 (2022). https://doi.org/10.1007/s10143-021-01566-6

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