Functional Outcomes After Resection of Middle Frontal Gyrus Versus Superior Frontal Gyrus tumors

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OBJECTIVE: Neurosurgical oncology outcomes are influenced by histological factors not available before surgery, complicating preoperative counseling regarding surgical risks. Anatomically tailored outcome data have demonstrated potential predictive value. This study aims to compare the incidence of supplementary motor area (SMA) syndrome and other postoperative outcomes for tumors in the middle and superior frontal gyri undergoing resection. METHODS: A retrospective single-center cohort study of patients undergoing resection of the middle frontal gyrus (MFG), superior frontal gyrus (SFG), or both (SMFG) from 2008 to 2020. The study followed STROBE guidelines. RESULTS: A total of 124 patients underwent 144 craniotomies. Seizures were the most common preoperative symptom, particularly in patients with MFG tumors, who also had higher rates of preoperative aphasia. Pathology varied significantly (P < 0.05) between groups, with glioblastoma multiforme more prevalent in SMFG tumors and metastases more common in MFG tumors. Supplementary motor area (SMA) syndrome occurred in 43%, more frequently in SFG tumors (47%) compared to MFG (40%) and SMFG (27%), although these differences were not statistically significant. SMA syndrome duration varied significantly (P < 0.05) across groups, with SMFG cases being the most persistent. Early postoperative aphasia was more common (P < 0.001) in MFG cases (55%), but there were no permanent deficits in the MFG group. The SMFG group had more permanent neurological deficits and higher rates of early complications (P < 0.05). Survival was significantly lower in SMFG tumors (P < 0.05) on univariate analysis but not on multivariate analysis. CONCLUSIONS: The study found no significant difference in SMA syndrome frequency by location, although the duration of SMA syndrome was significantly longer in SMFG cases. Postoperative aphasia was more common in MFG tumors but was temporary. Permanent deficits were rare across all regions. These anatomically tailored findings provide valuable information for surgical planning and patient counseling.

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