Surgery of Intrinsic Brain Tumors in the Superior Frontal Gyrus

Abstract

Background The superior frontal gyrus (SFG) is home to the supplementary motor area (SMA), which is essential in the planning, initiation and execution of language and motor function, and is heavily involved in cognitive / neuropsychological circuits. Due to the vast interconnectedness of the SFG and SMA, resection of intrinsic brain tumors thus poses a significant challenge to avoid surgically induced morbidity and postoperative deficits. The aim of this study was to explore transient and permanent neuro(psycho)logical outcomes of patients with primary brain tumors in the SFG, particularly focusing on the transient nature of the SMA syndrome and assessing the correlation of varying parameters and the subsequent development of postoperative neuro(psycho)logical deficits. Methods Data were gathered by means of retrospective chart review. Data evaluated included preoperative tumor volume, tumor laterality, type of surgery (awake versus asleep), WHO CNS grade, Karnofsky Performance Status (KPS) and return to work. Fisher’s Exact Tests, Chi-Square tests of independence, and binary logistic regression models were used to assess statistically significant correlations. P-values < 0.05 were considered statistically significant. Results Thirty-one patients were included from 2018 to 2023, 21 (67.7%) with left-sided tumors, ten (32.3%) with right-sided tumors. Twenty-one (67.7%) patients underwent awake surgery, ten (32.3%) were operated on asleep. Examining neuro(psycho)logical deficits, there were no statistically significant correlations with preoperative tumor volume, laterality, resection of the middle frontal gyrus (MFG), cingulate gyrus (CG), or fibers of the corpus callosum (CC). Type of surgery (p = 0.027) and WHO CNS grade (p = 0.028, p = 0.044) were statistically significant predictors, especially for permanent deficits. Conclusions This study has underscored the transient nature of the SMA syndrome and reiterated the importance of awake surgery for primary brain tumors, especially to mitigate postoperative neuro(psycho)logical deficits to ensure the best balance between neurooncological outcome and health-related quality of life.

Datum der Bewilligung	2025
Originalsprache	Englisch
Gradverleihende Hochschule	Medizinische Universität Graz
Betreuer/-in	Michael Mokry (Betreuer*in) & Kariem Mahdy Ali (Mitbetreuer*in)