Anatomical analysis of white fiber tracts in SMA and its implications related to en-masse tumor resection technique.

Autor: Shah A; Department of Neurosurgery, K.E.M. Hospital and Seth G.S. Medical College, Parel, Mumbai, India; Center for Advanced Neurosurgery, K.J. Somaiya Hospital and Research Center, Mumbai, India., Vutha R; Center for Advanced Neurosurgery, K.J. Somaiya Hospital and Research Center, Mumbai, India., Prasad A; Department of Neurosurgery, Lilavati Hospital and Research Center, Mumbai, India., Goel A; Center for Advanced Neurosurgery, K.J. Somaiya Hospital and Research Center, Mumbai, India; Department of Neurosurgery, Lilavati Hospital and Research Center, Mumbai, India. Electronic address: abhidhashah@kem.edu.
Jazyk: angličtina
Zdroj: Journal of clinical neuroscience : official journal of the Neurosurgical Society of Australasia [J Clin Neurosci] 2024 Jun; Vol. 124, pp. 130-136. Date of Electronic Publication: 2024 May 04.
DOI: 10.1016/j.jocn.2024.04.025
Abstrakt: Objective: Anatomy and connections of the supplementary motor area (SMA) are studied essentially to analyze the SMA syndrome. Experience with surgical treatment of 19 tumors located in SMA is analyzed.
Material and Methods: The cortical anatomy and subcortical connectivity of the SMA was studied on ten previously frozen and formalin fixed human cadaveric brain specimens. The white fiber dissection was performed using Klingler's method. Nineteen patients with low grade gliomas in the region of the SMA treated surgically were clinically analyzed.
Results: The white fiber connections of the SMA include short arcuate connections with the pre-central, middle and inferior frontal gyri, the medial part of the SLF, the cingulum, the frontal aslant tract (FAT), the claustro-cortical fibers, the fronto-striatal tract and the crossed frontal aslant tract. All tumors were operated using en-masse surgical technique described by us and its subsequent modifications that focused on attempts towards preservation of related critical fiber tracts namely FAT, cingulum and corpus callosum presumed to be responsible for postoperative SMA syndrome. Eight patients developed an SMA syndrome in the immediate post-operative period. Eleven patients did not develop any post-operative neurological deficits. In all these 11 patients it was apparent that the cingulum, FAT and the corpus callosal fibers were preserved during surgery by modifying the tumor resection technique.
Conclusions: SMA syndrome is a frequent occurrence following surgery in patients with tumors in the region of the SMA complex. Surgical strategy that preserves the cingulum and the FAT can prevent the occurrence of the SMA syndrome.
Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.
(Copyright © 2024. Published by Elsevier Ltd.)
Databáze: MEDLINE
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