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Journal of Neurosurgical Sciences 2021 Apr 16

DOI: 10.23736/S0390-5616.21.05344-3

Copyright © 2021 EDIZIONI MINERVA MEDICA

lingua: Inglese

Functional anatomy of the frontal aslant tract and surgical perspectives

Eléonor BURKHARDT 1, Masashi KINOSHITA 2, Guillaume HERBET 3, 4

1 Praxiling, CNRS UMR 5267, Paul Valéry Montpellier 3 University, Montpellier, France; 2 Department of Neurosurgery, Kanazawa University, Kanazawa, Ishikawa, Japan; 3 University of Montpellier, CNRS UMR5203, INSERM U1191, Institute of Functional Genomics, Montpellier, France; 4 Department of Neurosurgery, Gui de Chauliac Hospital, Montpellier University Medical Center, Montpellier, France


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The frontal aslant tract (FAT) is an intralobar white matter fasciculus providing dense connections between the medial part of the superior frontal gyrus, in particular the pre-supplementary motor area (SMA) and the SMA proper, and the lateral part of the frontal lobe, especially the inferior frontal gyrus. Although this tract has been characterized belatedly, it has received important attention in recent years due notably to its increasingly evidenced role in the speech and language networks. As cerebral tumors frequently affect the frontal lobe, an improved knowledge of the functional anatomy of the FAT is mandatory to refine the way neurosurgeries are performed and to give the patients the best opportunities to recover after surgery. In this work, we first describe the spatial arrangement of the FAT and detail its cortical projections. We then provide a comprehensive review of the functions supposedly mediated by this transverse frontal connectivity. It is structured following a tripartite organization where the linguistic (i.e. speech and language), supralinguistic (i.e. functions that interact with speech and language: executive functions, working memory, and social communication) and extralinguistic implications (i.e. functions outside the linguistic domain: visuospatial processing, praxis and motor skills) are successively addressed. We lastly discussed this knowledge in the context of wide-awake neurosurgeries for brain tumors. We emphasize the need to evaluate thoroughly the functions conveyed by FAT by means of longitudinally-designed studies to first estimate its plasticity potential and then to determine which tasks should be selected to avoid lasting impairments due to its disconnective breakdown.


KEY WORDS: Frontal aslant tract; Frontal connectivity; Speech; Language; Executive functions; Electrostimulation mapping; Glioma; Awake surgery

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