Neurological and functional recovery after supplementary motor area glioma resection: A 15-year single-center cohort study

Objectives Glioma resection in the supplementary motor area (SMA) can cause postoperative SMA syndrome with acute motor, speech, and functional decline. We aimed to characterize neurological and functional recovery trajectories and evaluate surgical safety and postoperative care requirements. Methods We conducted a retrospective single-center cohort study of adults undergoing resection of WHO grade 2-4 gliomas involving or adjacent to the SMA between 2009 and 2024. Clinical, radiological, surgical, functional, and postoperative care data were extracted from medical records. Motor function, language, gait, and ECOG performance status were assessed preoperatively, on postoperative days 1 and 7, at discharge, and at follow-up. Results Forty-six patients were included (mean age 41.5 years). Severe motor deficits and severe language impairment occurred in 54.3% and 56.5%, respectively, on the first postoperative day, decreasing to 8.9% for both domains at first follow-up. Most patients recovered substantially within 3 months, although mild residual motor or language difficulties and reduced ECOG performance status persisted in a subset. Older age was associated with persistent arm paresis. Gross total resection was achieved in 71.7%, 30-day mortality was 0%, and postoperative morbidity occurred in 17.4%. At discharge, 39% were transferred to specialized rehabilitation and 85% of those discharged home received community-based rehabilitation. Conclusion Postoperative SMA syndrome was common and often clinically dramatic, but most deficits improved substantially by 3 months. Persistent ECOG limitations despite neurological recovery indicate that outcome assessment should extend beyond motor and language function. These findings support structured preoperative counselling, comprehensive postoperative assessment, and early discharge planning after SMA-region glioma surgery.