The Microsurgical and Tractographic Anatomy of the Supplementary Motor Area Complex in Human.

The Microsurgical and Tractographic Anatomy of the Supplementary Motor Area Complex in Human.

World Neurosurg. 2016 Jul 28;

Authors: Bozkurt B, Yagmurlu K, Middlebrooks EH, Karadag A, Ovalioglu TC, Jagadeesan B, Sandhu G, Tanriover N, Grande AW

Abstract
OBJECTIVE: To evaluate the microsurgical anatomy of the fiber tract connections of the supplementary and pre-supplementary motor areas, and its potential functional role with reference to clinical trials in the literature.
METHODS: 10 postmortem formalin-fixed human brains (20 sides) and 1 cadaveric head were prepared with Klingler's method. The fiber dissection was performed in a stepwise fashion, both from lateral to medial and medial to lateral under an operating microscope with 3D images captured at every stage. Our findings were supported with in vivo MRI tractography in 2 healthy subjects.
RESULTS: The connections of the supplementary motor area complex, composed of pre- supplementary motor area and supplementary motor area proper, are composed of short "U" association fibers, superior longitudinal fasciculus I, cingulum, claustrocortical fibers, callosal fibers, corticospinal, frontal aslant, and frontostriatal tracts. The claustrocortical fibers may play an important role in integration of motor, language, and limbic functions of the supplementary motor area complex. The frontostriatal tract connects the pre-SMA to putamen and caudate nucleus, as well as forming part of both the internal capsule and dorsal external capsule.
CONCLUSIONS: SMA Complex has numerous connections throughout the cerebrum. An understanding of these connections is important for presurgical planning of lesions in the frontal lobe and helps explain symptoms related to SMA injury.

PMID: 27476690 [PubMed - as supplied by publisher]

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