Abstract
The frontal aslant tract (FAT) is a recently identified white matter tract connecting the supplementary motor complex and lateral superior frontal gyrus to the inferior frontal gyrus. Advancements in neuroimaging and refinements to anatomical dissection techniques of the human brain white matter contributed to the recent description of the FAT anatomical and functional connectivity and its role in the pathogenesis of several neurological, psychiatric, and neurosurgical disorders. Through the application of diffusion tractography and intraoperative electrical brain stimulation, the FAT was shown to have a role in speech and language functions (verbal fluency, initiation and inhibition of speech, sentence production, and lexical decision), working memory, visual–motor activities, orofacial movements, social community tasks, attention, and music processing. Microstructural alterations of the FAT have also been associated with neurological disorders, such as primary progressive aphasia, post-stroke aphasia, stuttering, Foix–Chavany–Marie syndrome, social communication deficit in autism spectrum disorders, and attention–deficit hyperactivity disorder. We provide a systematic review of the current literature about the FAT anatomical connectivity and functional roles. Specifically, the aim of the present study relies on providing an overview for practical neurosurgical applications for the pre-operative, intra-operative, and post-operative assessment of patients with brain tumors located around and within the FAT. Moreover, some useful tests are suggested for the neurosurgical evaluation of FAT integrity to plan a safer surgery and to reduce post-operative deficits.
Highlights
Refinements in the study of the human brain white matter by different means, such as dissection and advanced MR imaging techniques are leading to the discovery of new brain pathways
From the discovery of such white matter tract many papers described its role in different functions, such as speech and language functions [15,16,17,18], working memory [19,20,21], and visual–motor activities [22,23,24,25], and its possible involvement in the pathogenesis of several neurological, psychiatric, and neurosurgical disorders, the awareness of such fascicle is still not well-popularized in the neurosurgical community
To review the available data about the frontal aslant tract (FAT), we started describing the anatomy and we highlight its role in different brain function fields, such as language, executive functions, lexical decisions, stuttering, orofacial movements, working memory, social community tasks, attention, and music processing
Summary
Refinements in the study of the human brain white matter by different means, such as dissection and advanced MR imaging techniques are leading to the discovery of new brain pathways. From the discovery of such white matter tract many papers described its role in different functions, such as speech and language functions [15,16,17,18], working memory [19,20,21], and visual–motor activities [22,23,24,25], and its possible involvement in the pathogenesis of several neurological, psychiatric, and neurosurgical disorders, the awareness of such fascicle is still not well-popularized in the neurosurgical community For this reason, we decided to perform a systematic literature review and to focus on the neurosurgical applications of the current knowledge on the FAT. Our objective is to suggest practical indications and useful tests for the pre-operative, intra-operative, and post-operative evaluation of patients with brain tumors located around and within this tract or patients undergoing frontal lobe epilepsy surgery, providing to the neurosurgeon useful information to plan a safer surgery and to reduce post-operative deficits
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