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This study evaluated whether postoperative SMA syndrome is associated with delayed initiation of adjuvant therapy and with progression-free survival (PFS) and overall survival (OS).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We performed a retrospective single-center study of patients undergoing resection of gliomas involving, adjacent to, or approached through the SMA between 2015 and 2024. SMA syndrome was defined as new-onset motor deficits and\/or language impairment without corresponding intraoperative neuromonitoring changes and without involvement of the primary motor cortex or corticospinal tract. Logistic and Cox regression analyses were performed.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Seventy-four patients were included, of whom 37 (50%) developed postoperative SMA syndrome. In univariate logistic regression, RANO class 2\u00a0A and class 2B resections were associated with higher odds of postoperative SMA syndrome compared with RANO class 1 resections (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.048 and\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.035, respectively). In the pairwise multivariable model, grouped RANO class 2 resections remained associated with higher odds of postoperative SMA syndrome compared with class 1 resections (OR 5.05, 95% CI 1.24\u201320.57;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.024). Postoperative SMA syndrome was not associated with delayed initiation of adjuvant therapy (HR 0.86, 95% CI 0.49\u20131.53;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.617), PFS (HR 1.21, 95% CI 0.63\u20132.32;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.573), or OS (HR 1.21, 95% CI 0.49\u20132.95;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.681). Postoperative functional decline (\u2265\u200920-point KPS decrease) was independently associated with receipt of modified or reduced-intensity adjuvant therapy (adjusted OR 13.91, 95% CI 2.21\u201387.64;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.005), whereas SMA syndrome itself was not associated with treatment modification.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Postoperative SMA syndrome was not associated with delayed adjuvant therapy or worse survival. Functional status, rather than SMA syndrome, influenced treatment intensity, supporting maximal safe resection in the SMA region.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s11060-026-05805-y","type":"journal-article","created":{"date-parts":[[2026,9,23]],"date-time":"2026-09-23T07:31:11Z","timestamp":1790148671000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Supplementary motor area syndrome in intracranial gliomas is not associated with worse survival"],"prefix":"10.1007","volume":"179","author":[{"given":"Dragan","family":"Jankovic","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sophie","family":"Rosenke","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jens","family":"Blobner","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrea","family":"Szel\u00e9nyi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Veit","family":"St\u00f6cklein","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Santhosh G.","family":"Thavarajasingam","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andreas","family":"Kramer","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Philipp","family":"Karschnia","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nico","family":"Teske","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Florian","family":"Ringel","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Darius","family":"Kalasauskas","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,9,23]]},"reference":[{"key":"5805_CR1","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1159\/000464374","volume":"30","author":"QT Ostrom","year":"2018","unstructured":"Ostrom QT, Gittleman H, Stetson L, Virk S, Barnholtz-Sloan JS (2018) Epidemiology of Intracranial Gliomas. 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