Unit:
Faculty of MedicineLibrary of the School of Health Sciences
Dissertation committee:
Στράντζαλης Γεώργιος, Καθηγητής, Ιατρική Σχολή, ΕΚΠΑ
Τρουπής Θεόδωρος, Καθηγητής, Ιατρική Σχολή, ΕΚΠΑ
Πιάγκου Μαρία, Αναπληρώτρια Καθηγήτρια, Ιατρική Σχολή, ΕΚΠΑ
Δεμεστιχα Θεανώ, Αναπληρώτρια Καθηγήτρια, Ιατρική Σχολή, ΕΚΠΑ
Σταυρινού Λάμπης, Επίκουρος Καθηγητής, Ιατρική Σχολή, ΕΚΠΑ
Τσακωτός Γεώργιος, Επίκουρος Καθηγητής, Ιατρική Σχολή, ΕΚΠΑ
Φιλίππου Δημήτριος, Επίκουρος Καθηγητής, Ιατρική Σχολή, ΕΚΠΑ
Original Title:
Ανατομική μελέτη των συνδέσεων του προμετωπιαίου φλοιού
Translated title:
Anatomical study of the connections of the prefrontal cortex
Summary:
INTRODUCTION : The prefrontal cortex occupies the largest surface of the frontal lobe facilitating the most of the cerebral executive functions. Although many white matter tracts interconnect the prefrontal cortex with the rest of the cerebrum, the prefrontal subcortical anatomy has been neglected by the current literature. A small number of studies have presented the pertinent white matter anatomy of the frontal lobe without a focus on the prefrontal connectivity. The purpose of the current study is the investigation of the white matter tracts of the prefrontal cortex.
MATERIALS AND METHODS : Fifteen adult cerebral hemispheres were used in the study. They were prepared with the Klingler s technique. The three segments of the prefrontal cortex: the dorsolateral prefrontal, the orbitofrontal cortex and the ventromedial prefrontal cortex were dissected according to the frozen-thaw technique. Thin metallic dissectors and anatomic forceps were used for the dissections and the augmentation of the neurosurgical microscope. The results were documented with a digital camera.
RESULTS : Nineteen white matter tracts contribute to the prefrontal connectivity. It was evident that seven fasciculi connect the dorsolateral prefrontal cortex with the rest of the hemisphere. These tracts were the short arcuate fibers, the frontal longitudinal system, the frontal aslant tract, the extreme capsule, the external capsule, the inferior occipitofrontal tract, the anterior limb of the internal capsule. Five fasciculi connect the orbitofrontal cortex with rest of the hemisphere : the short arcuate fibers, the Frontoorbitopolar tract, the uncinate tract, the anterior limb of the internal capsule. In the ventromedial segment of the prefrontal cortex, seven tracts were discovered to terminate the specific region : the short arcuate fibers, the cingulum, the SLF I, the uncinate fasciculus, the forceps minor, frontocaudate fibers and the anterior thalamic peduncle.
DISCUSION : A large amount of current scientific evidence verifies the results of the current study. The frontoorbitopolar tract was first explored in this research with white matter dissection technique. Additionally, the anatomical relation of the inferior occipitofrontal and uncinate fasciculus with the insular apex has special neurosurgical significance since it can facilitate the surgical treatment of the patients harboring malignant diffuse lesion in the area of the insula. In the same context, the location of the frontal aslant tract can be used as a landmark for navigation during the surgical excision of diffuse low grade glioma in the area of posterior prefrontal cortex under awake conditions.
CONCUSION : The complex connectivity of the prefrontal cortex has been revealed. Nineteen fiber tracts connect the prefrontal cortex to the parietal, temporal, occipital lobe, to the insula, the brainstem and the opposite hemisphere. The short arcuate fibers are more system of small tracts than one uniform compound fasciculus. The frontoorbitopolar tract was studied for the first time in the literature with the technique of the white matter dissection.
Main subject category:
Health Sciences
Keywords:
Prefrontal, Cortex, Tracts, White matter, Anatomy
Number of references:
138
