Hello, my name is Nicholas Cedario and I'm a second year medical student at Rutgers Robert Wood Johnson Medical School. Today I'll be presenting the frontosalient tract regarding supplementary motor area syndrome, and this project was done under the supervision and mentorship of Dr. Michael Shugarov. We have no conflicts of interest related to the current project. There is a likely string of higher-order cognitive networks that spans the medial frontal lobe. It generally includes the default motor network and the stannous network that link and extend up into the supplementary motor area. Now, multiple lines of evidence support this possible initiation axis, both from neuroimaging studies as well as from lesion studies in the medial frontal lobe that show damage to this exact axis will cause akinetic mutism. Therefore, this initiation axis is likely responsible for internally modeling goal initiation and spontaneous activity, such as for the initiation of speech and motor planning. Therefore, it's important to know that supplementary motor area syndrome is characterized by mutism and hemiplegia, which can more easily be understood as deficits related to the failure to initiate movement or speech. A recently described white matter bundle is the frontosalient tract, or the FAT. The FAT has two functions that we're aware of currently. The two main functions likely are linking the hubs of the stannous network, as well as connecting the supplementary motor area to Broca's area. You can see these in the two diagrams currently shown. Because of this, and because of its role in the initiation axis, we recently looked at our data to see if the role of preserving the FAT can play in preventing supplementary motor area syndrome. With tractographic visualization of the FAT, as well as the surrounding connectomic architecture, when trying to preserve the FAT, we can see that tumors of the SMA can either push the FAT posteriorly towards the primary motor cortex, as seen in the left diagram, or the tumor can be between the FAT and the primary cortex, pushing the FAT anteriorly, as seen in the right diagram. When reviewing our own retrospective data, we wanted to see the difference in avoiding the FAT in causing transient and permanent SMA syndrome, compared to just adhering to the traditional dogma of avoiding the superior frontal gyrus in hopes of avoiding causing SMA syndrome. When we look at this here, we have our results. We see that by avoiding the FAT, there's a significant decrease in the cases of transient SMA syndrome, 11 cases compared to 2, whereas there was no significant difference between permanent SMA syndrome, between both control and experimental groups, while there was still a decrease in the FAT preservation group. In conclusion, preservation of the cortical regions of the SMA and its targets, as well as the frontal salient tract specifically, seems to be useful in reducing transient SMA syndrome. Improved understanding of the connectomic architecture in the human cerebrum, such as the initiation axis in the medial frontal lobe, will help us better leverage and understand how to improve cognitive mobility following brain tumor surgery moving forward. These are our references, and thank you for attending our talk today.

Nicholas Cedario

frontosalient tract

supplementary motor area syndrome

Dr. Michael Shugarov

akinetic mutism