The Frontal Aslant Tract: A Systematic Review for Neurosurgical Applications

The Frontal Aslant Tract (FAT) is a recently identified white matter tract connecting the Supplementary Motor Complex (SMC)and lateral Superior Frontal Gyrus (SFG) to the Inferior Frontal Gyrus (IFG). Advancements in neuroimaging and refinements to anatomical dissection techniques of 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 showed 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 been also 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.