Surgery for supplementary motor area gliomas—Controversies and rationale for surgical approach: A perspective

Abstract

Abstract Supplementary motor area (SMA) has a role in planning and coordinating motor movements as well as in speech (dominant SMA). SMA gliomas are complex tumors to operate on and sufficient knowledge regarding connection fibers is needed to plan and prevent complications, the most important being SMA syndrome. Development of SMA syndrome causes significant morbidity and although SMA syndrome is transient and the majority of symptoms are relieved over time some symptoms persist that may lead to loss of quality of life in these patients. A thorough review of the literature was done to expand on the white matter tracts connecting SMA to other eloquent regions, SMA syndrome, best surgical practices for SMA gliomas (addressing the dilemma of awake vs. asleep craniotomy), and intraoperative monitoring techniques being used currently. An attempt has been made to address the debate regarding outcomes and controversies in the treatment of SMA region gliomas and we have also presented our experience through three case illustrations, which include two cases of SMA gliomas operated under asleep monitoring and one case operated under awake monitoring.