Localization and parcellation of the supplementary motor area using functional magnetic resonance imaging in frontal tumor patients

Abstract

Neurosurgery is an effective method for prolonging life and improving outcomes for patients with brain tumors. However, this option bears the risk of damaging areas of eloquent cortex, areas associated with motor and language tasks that, when lesioned, will result in a functional deficit for the patient. Functional magnetic resonance imaging (fMRI) is a valuable tool in the localization of eloquent cortex for preoperative neurosurgical planning. Through use of this modality of functional neuroimaging, the neurosurgeon can adjust the surgical trajectory to incur the least amount of damage to sites of functional activity. The supplementary motor area (SMA) is one such site of eloquent cortex that must be visualized preoperatively due to the risk of postoperative deficit with lesions in this area. However, due to both the effects of tumor pathology and naturally occurring interindividual variability, the SMA’s location and functional fingerprint can be highly variable. We present a study in which patients with frontal tumor (n=46) underwent task-based fMRI for motor and language network mapping. The patient-specific functional data were normalized and evaluated using ROI analysis to illustrate group-level activation patterns within the SMA during the language and motor tasks. The results illustrate a distinct pattern of activation including a rostro-caudal organization of language and motor activation, overlapping extent cluster volumes throughout the two functional subdivisions of the SMA, the pre-SMA and SMA proper, and discrete activation foci.