A Practical Approach to Imaging of the Supplementary Motor Area and Its Subcortical Connections
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BEHAVIOR (H.S. KIRSHNER, SECTION EDITOR)
A Practical Approach to Imaging of the Supplementary Motor Area and Its Subcortical Connections Mar Jiménez de la Peña 1 & Santiago Gil-Robles 2 & Vicente Martínez de Vega 1 & Cristina Aracil 2 & Agustín Acevedo 3 & Manuel Recio Rodríguez 1 Published online: 15 September 2020 # Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Purpose of Review First, an anatomical and functional review of these cortical areas and subcortical connections with T-fMRI and tractography techniques; second, to demonstrate the value of this approach in neurosurgical planning in a series of patients with tumors close to the SMA. Recent Findings Implications in language and cognitive networks with a clear hemispheric lateralization of these SMA/pre-SMA. The recommendation of the use of the advanced neuroimaging studies for surgical planning and preservation of these areas. Summary The SMA/pre-SMA and their subcortical connections are functional areas to be taken into consideration in neurosurgical planning. These areas would be involved in the control/inhibition of movement, in verbal expression and fluency and in tasks of cognitive control capacity. Its preservation is key to the patient’s postsurgical cognitive and functional evolution. Keywords Supplementary motor area . Presupplementary motor area . Task-functional MRI . Resting-functional MRI . Electrical cortical mapping . Electrical subcortical mapping . Tractography
Introduction Direct intraoperative corticosubcortical mapping is the gold standard to reveal eloquent areas close to intraaxial brain tumors. Noninvasive preoperative imaging, with techniques such as task-related functional MR (T-fMRI), and tractography can assist in neurosurgical planning and help reduce intervention time [1–4, 5•]. Successful application of these techniques requires an in-depth understanding of the technique itself and also of the anatomy and corticosubcortical connections, in order to be able to correctly interpret the
This article is part of Topical Collection on Behavior * Mar Jiménez de la Peña [email protected] 1
Department of Radiology, Hospital Universitario QuironSalud Madrid, C/ Diego de Velázquez 1, Pozuelo de Alarcón, 28223 Madrid, Spain
2
Department of Neurosurgery, Hospital Universitario QuironSalud Madrid, Pozuelo de Alarcón, Madrid, Spain
3
Department of Pathology, Hospital Universitario QuironSalud Madrid, Pozuelo de Alarcón, Madrid, Spain
images, often artifacted by significant perilesional edema, bleeding, or extensive tumoral infiltration. On the other hand, cognitive impairment in these patients often makes it difficult for them to perform the tasks in TfMRI studies, limiting the validity of the technique. In these patients, it may be preferable to use resting-state functional magnetic resonance imaging (R-fMRI) [6•, 7], as this does not require the patient’s active collaboration to reveal the areas of the brain involved in the networks, although there are limitations to its use in daily practice [8].
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