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J Neurosurg ; 128(6): 1865-1872, 2018 06.
Article in English | MEDLINE | ID: mdl-28862541

ABSTRACT

OBJECTIVE The orbitofrontal cortex (OFC) is understood to have a role in outcome evaluation and risk assessment and is commonly involved with infiltrative tumors. A detailed understanding of the exact location and nature of associated white matter tracts could significantly improve postoperative morbidity related to declining capacity. Through diffusion tensor imaging-based fiber tracking validated by gross anatomical dissection as ground truth, the authors have characterized these connections based on relationships to other well-known structures. METHODS Diffusion imaging from the Human Connectome Project for 10 healthy adult controls was used for tractography analysis. The OFC was evaluated as a whole based on connectivity with other regions. All OFC tracts were mapped in both hemispheres, and a lateralization index was calculated with resultant tract volumes. Ten postmortem dissections were then performed using a modified Klingler technique to demonstrate the location of major tracts. RESULTS The authors identified 3 major connections of the OFC: a bundle to the thalamus and anterior cingulate gyrus, passing inferior to the caudate and medial to the vertical fibers of the thalamic projections; a bundle to the brainstem, traveling lateral to the caudate and medial to the internal capsule; and radiations to the parietal and occipital lobes traveling with the inferior fronto-occipital fasciculus. CONCLUSIONS The OFC is an important center for processing visual, spatial, and emotional information. Subtle differences in executive functioning following surgery for frontal lobe tumors may be better understood in the context of the fiber-bundle anatomy highlighted by this study.


Subject(s)
Diffusion Tensor Imaging/methods , Neural Pathways/anatomy & histology , Neural Pathways/diagnostic imaging , Prefrontal Cortex/anatomy & histology , Prefrontal Cortex/diagnostic imaging , White Matter/anatomy & histology , White Matter/diagnostic imaging , Brain Stem/anatomy & histology , Brain Stem/diagnostic imaging , Cadaver , Cerebral Cortex/anatomy & histology , Cerebral Cortex/diagnostic imaging , Connectome , Dissection , Functional Laterality , Humans , Pyramidal Tracts/anatomy & histology , Pyramidal Tracts/diagnostic imaging , Thalamus/anatomy & histology , Thalamus/diagnostic imaging
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