Objective To investigate the clinical features, surgical strategy and efficacy of lesions in Supplementary motor area.Metheds The clinical data of 11 patients with tumors in Supplementary motor area admitted to the First Affiliated Hospital of Fujian Medical University from January 2021 to December 2023 were retrospectively analyzed, and their clinical features, surgical strategy and efficacy were summarized, and the related literature was reviewed.Results 5 cases started with epilepsy, 4 cases started with headache and dizziness, 1 case started with limb weakness, and 1 case was found by physical examination.The tumor was located in the left SMA area in 7 cases and the right in 4 cases.Intraoperative wake-up anesthesia under neuronavigation combined with electrophysiological monitoring in 3 cases of tumor resection, neuronavigation combined with electrophysiological monitoring in 7 cases, the other 1 case with traditional craniotomy, 8 cases of total tumor resection, and 3 cases of partial resection.Supplementary motor area syndrome occurred in 10 patients after surgery, and all recovered within weeks to months.Postoperative pathology: 7 cases of WHO grade II (6 cases of oligodendroglioma, 1 case of diffuse astrocytoma), 4 cases of WHO grade III (3 cases of anaplastic astrocytoma and 1 case of anaplastic oligodendroglioma).Conclusion Low-grade gliomas are more common in supplementary motor area tumors, and often start with epileptic seizures. Safe total tumor resection can be achieved under the guidance of multimodal auxiliary technology,Preoperative DTI techniques can aid in the development of surgical strategies.Supplementary motor area syndrome usually resolves completely within weeks to months after surgery.