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AJNR - American Journal of Neuroradiology

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Supplementary Motor Area Activation in Patients with Frontal Lobe Tumors and Arteriovenous Malformations

Janet Sailor^a, M. Elizabeth Meyerand^b, Chad H. Moritz^a, Jason Fine^c, Lindsey Nelson^a, Behnam Badie^d and Victor M. Haughton^a

^a Department of Radiology, University of Wisconsin Medical School, Madison, Wisconsin
^b Department of Medical Physics, University of Wisconsin Medical School, Madison, Wisconsin
^c Department of Biostatistics, University of Wisconsin Medical School, Madison, Wisconsin
^d Department of Neurological Surgery, University of Wisconsin Medical School, Madison, Wisconsin

View larger version (120K): [in a new window]   FIG 1. Patient with left arm weakness and a right frontal lobe AVM overlapping the SMA region. Axial functional MR image illustrates activation of the left SMA (arrow) and right sensorimotor cortex during a left finger-tapping task.

View larger version (66K): [in a new window]   FIG 2. 23-year-old female patient with a right frontal lobe tumor contiguous with the SMA region, who showed preoperative left upper extremity numbness, left pronator drift, and gait disturbance. Axial functional MR images illustrate bilateral SMA activation during a left finger-tapping task.

View larger version (96K): [in a new window]   FIG 3. 35-year-old male patient with a right frontal lobe tumor noncontiguous with the SMA region and no preoperative neurologic deficit. Axial functional MR image illustrates bilateral SMA activation during a left finger-tapping task

View larger version (95K): [in a new window]   FIG 4. A and B, Axial functional MR images show activation in sensorimotor cortex and SMA for left finger (A) and right finger (B) motor tasks in a healthy volunteer. All control subjects demonstrated left SMA dominance for the right finger task; 43% of the control subjects showed right SMA dominance for the left finger task.

View larger version (92K): [in a new window]   FIG 5. Axial functional MR images show activation from right motor tasks in the two patients with left frontal masses overlapping the SMA in whom reorganization of SMA was detected. A, Activation in the SMA (red arrows) is contralateral to the sensorimotor cortex activation (black arrows) in a patient with a large meningioma. B, In a patient with a grade II oligodendroglioma, activation secondary to the right finger task is noted in the right SMA (red arrow) and in the left sensorimotor cortex (black arrow)

View larger version (85K): [in a new window]   FIG 6. A–C, Axial functional MR images show activation from left motor tasks in three patients with right frontal AVM (A) or tumor (B and C) contiguous with the SMA. Activation in the SMA was identified in the left hemisphere in each case.