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Postoperative speech disorder after medial frontal surgery

Role of the supplementary motor area

From the Departments of Neuroradiology (Drs. Krainik, Lehéricy, Chainay, and Marsault), Neurosurgery (Drs. Duffau, Capelle, Cornu, and Boch), and Neurology (Dr. Cohen), Hôpital de la Salpêtrière, Paris; and Department of Medical Research (Drs. Lehéricy, Mangin, and Le Bihan), Service Hospitalier Frédéric Joliot, and IFR 49, CEA, Orsay, France.

Address correspondence and reprint requests to Dr. S. Lehéricy, Department of Neuroradiology, Bâtiment Babinski, Hôpital de la Salpêtrière, 47 Bd. de l’Hôpital, 75013 Paris, France; e-mail: stephane.lehericy{at}psl.ap-hop-paris.fr

Background: Patients undergoing surgical resection of medial frontal lesions may present transient postoperative speech disorders that remain largely unpredictable.

Objective: To relate the occurrence of this speech deficit to the specific surgical lesion of the supplementary motor area (SMA) involved during language tasks using fMRI.

Methods: Twelve patients were studied using a verbal fluency task before resection of a low-grade glioma of the medial frontal lobe and compared with six healthy subjects. Pre- and postoperative MR variables including the hemispheric dominance for language, the extent of SMA removal, and the volume of resection were compared to the clinical outcome.

Results: Following surgery, 6 of 12 patients presented speech disorders. The deficit was similar across patients, consisting of a global reduction in spontaneous speech, ranging from a complete mutism to a less severe speech reduction, which recovered within a few weeks or months. The occurrence of the deficit was related to the resection of the activation in the SMA of the dominant hemisphere for language (p < 0.01). Increased activation in the SMA of the healthy hemisphere on the preoperative fMRI was observed in patients with postoperative speech deficit.

Conclusions: fMRI is able to identify the area at risk in the SMA, of which resection is related to the occurrence of characteristic transient postoperative speech disorders. Increased SMA activation in the healthy hemisphere suggested that a plastic change of SMA function occurred in these patients.

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