Contralateral functional reorganization of the speech supplementary motor area following neurosurgical tumor resection

• Published in: Brain and language Vol. 183; pp. 41 - 46
• Main Authors: Chivukula, Srinivas, Pikul, Brian K., Black, Keith L., Pouratian, Nader, Bookheimer, Susan Y.
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier Inc 01-08-2018; Academic Press
• Subjects: Adult; Astrocytoma - surgery; Brain cancer; Brain Neoplasms - surgery; Contralateral; Fluency; Functional magnetic resonance imaging; Humans; Magnetic Resonance Imaging; Male; Motor Cortex - diagnostic imaging; Motor Cortex - physiopathology; Motor Cortex - surgery; Mutism; Neuronal Plasticity - physiology; Neurosurgical Procedures - adverse effects; Patients; Plasticity; Postoperative Complications - diagnostic imaging; Postoperative Complications - physiopathology; Reaction time; Reorganization; SMA; Speech; Speech - physiology; Speech Disorders - diagnostic imaging; Speech Disorders - physiopathology; Speech SMA; Speech-language pathology; Supplementary motor area; Surgery; Supplementary motor area; Contralateral; Speech SMA; SMA; Reorganization
• ISSN: 0093-934X; 1090-2155
• DOI: 10.1016/j.bandl.2018.05.006

•Speech supplemental motor area (SMA) exhibits plasticity through contralateral homologous functional tissue recruitment.•Speech SMA neural plasticity is a dynamic, time-based process.•Functional reorganization of speech SMA activity may serve as a noninvasive neural marker for SMA syndrome recovery.
We evaluated plasticity in speech supplemental motor area (SMA) tissue in two patients using functional magnetic resonance imaging (fMRI), following resection of tumors in or associated with the dominant hemisphere speech SMA. Patient A underwent resection of a anaplastic astrocytoma NOS associated with the left speech SMA, experienced SMA syndrome related mutism postoperatively, but experienced full recovery 14 months later. FMRI performed 32 months after surgery demonstrated a migration of speech SMA to homologous contralateral hemispheric regional tissue. Patient B underwent resection of a oligodendroglioma NOS in the left speech SMA, and postoperatively experienced speech hesitancy, latency and poor fluency, which gradually resolved over 18 months. FMRI performed at 64 months after surgery showed a reorganization of speech SMA to the contralateral hemisphere. These data support the hypothesis of dynamic, time based plasticity in speech SMA tissue, and may represent a noninvasive neural marker for SMA syndrome recovery.