Medical Student Mayo Clinic Alix School of Medicine Rochester, Minnesota, United States
Introduction: Following resection of posterior superior frontal gyrus (PSFG) tumors, patients can experience supplementary motor area (SMA) syndrome consisting of contralateral hemiapraxia and/or speech apraxia. Given the heterogeneity of PSFG tumors, we aim to determine the risk of postoperative deficits and assess predictors of outcomes for all intraparenchymal SMA-region tumors undergoing surgery (biopsy or resection) regardless of histology.
Methods: This is a retrospective single center cohort study of adult PSFG-region tumors undergoing biopsy or resection by a single surgeon.
Results: 107 consecutive patients undergoing 125 procedures (21 biopsies, 104 resections) fulfilled inclusion/exclusion criteria. Anaplastic astrocytomas were most frequent among resected tumors (39% vs 29%), while glioblastomas were most common among biopsies (38% vs 28%) (p < 0.0001). Biopsy patients were more likely to have tumor involvement outside of the SFG (91% vs 63%) p=0.012), most commonly in the motor cortex (67% vs 31%)(p=0.003). Seizures were the most common presenting symptom among resection patients (p=0.017) while motor deficits were more common in biopsy patients (58% vs 29%)(p < 0.0001). Immediate postoperative neurological deficits occurred in 71 patients (57%), but only 3 were permanent at 6 months follow-up (2%). Postoperative SMA syndrome occurred in 49 patients (47%) and was significantly associated with involvement of the motor cortex (p=0.019) or cingulate gyrus (p=0.023), and previous radiation (p=0.003); however, extent of resection was not significantly associated with postop SMA syndrome (p = 0.060). Postop SMA syndrome occurrence did not show differences in overall survival duration (p=0.51). In multivariate analysis, both glioblastoma and metastasis histology were significantly associated with increased mortality risk: HR 8.28 95%CI (2.81-24.41)(p < 0.001).
Conclusion : Nearly half of all patients undergoing surgery for PSFG-region tumors experience a post-operative SMA syndrome. However, these deficits are usually transient, and the risk of new permanent deficits is very low (2%). Tumor pathology serves as the best predictor of overall survival.
