Abstract
Focal white matter lesions can cause cognitive impairments due to disconnections within or between networks. There is some preliminary evidence that there are specific hubs and fiber pathways that should be spared during surgery to retain cognitive performance. A tract potentially involved in important higher-level cognitive processes is the frontal aslant tract. It roughly connects the posterior parts of the inferior frontal gyrus and the superior frontal gyrus. Functionally, the left frontal aslant tract has been associated with speech and the right tract with executive functions. However, there currently is insufficient knowledge about the right frontal aslant tract’s exact functional importance. The aim of this study was to investigate the role of the right frontal aslant tract in executive functions via a lesion-symptom approach. We retrospectively examined 72 patients with frontal glial tumors and correlated measures from tractography (distance between tract and tumor, and structural integrity of the tract) with cognitive test performances. The results indicated involvement of the right frontal aslant tract in shifting attention and letter fluency. This involvement was not found for the left tract. Although this study was exploratory, these converging findings contribute to a better understanding of the functional frontal subcortical anatomy. Shifting attention and letter fluency are important for healthy cognitive functioning, and when impaired they may greatly influence a patient’s wellbeing. Further research is needed to assess whether or not damage to the right frontal aslant tract causes permanent cognitive impairments, and consequently identifies this tract as a critical pathway that should be taken into account during neurosurgical procedures.
Highlights
A major goal in brain tumor surgery is to understand the functionality of peritumoral tissue in order to safely optimize the resection
In 99 of these 182 cases, the tumor was located in the frontal lobe, 16 of which were not eligible based on the exclusion criteria (12 underwent brain surgery in the past, 3 had major medical comorbidities and 1 was incompetent in Dutch)
The unadjusted p-values are presented in bold if they remained significant after correction for multiple comparisons
Summary
A major goal in brain tumor surgery is to understand the functionality of peritumoral tissue in order to safely optimize the resection. The functional importance of white matter pathways has been increasingly acknowledged in surgical planning. For higher cognitive functions, such as executive functioning, there are no such protocols yet. Their nomenclature is widely discussed, executive functions can be described as ‘a set of general-purpose control mechanisms that regulate the dynamics of human cognition and action’ (Miyake & Friedman, 2012). Executive functions (including inhibition, working memory, planning, monitoring) are often linked to the frontal lobe, and their impairment likely has significant negative implications for normal social and professional life (Duffau & Mandonnet, 2013; Mischel et al, 2011; Moffitt et al, 2011)
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
