• Faidon Liakos, Spyridon Komaitis, Evangelos Drosos, Eleftherios Neromyliotis, Georgios P Skandalakis, Apostolos I Gerogiannis, Aristotelis V Kalyvas, Theodore Troupis, George Stranjalis, and Christos Koutsarnakis.
• Athens Microneurosurgery Laboratory, Evangelismos Hospital, Athens, Greece; Department of Anatomy, Medical School, National and Kapodistrian University of Athens, Athens, Greece.
• World Neurosurg. 2021 Aug 1; 152: e625-e634.

BackgroundRecent studies advocate a connectivity pattern wider than previously believed of the uncinate fasciculus that extends to the ventrolateral and dorsolateral prefrontal cortices. These new percepts on the connectivity of the tract suggest a more expansive role for the uncinate fasciculus. Our aim was to shed light on this controversy through fiber dissections.MethodsTwenty normal adult human formalin-fixed cerebral hemispheres were used. Focused dissections on the insular, orbitofrontal, ventromedial, ventrolateral, and dorsolateral prefrontal areas were performed to record the topography of the frontal terminations of the uncinate fasciculus.ResultsThree discrete fiber layers were consistently disclosed: the first layer was recorded to terminate at the posterior orbital gyrus and pars orbitalis, the second layer at the posterior two thirds of the gyrus rectus, and the last layer at the posterior one third of the paraolfactory gyrus. The insular apex was documented as a crucial landmark regarding the topographic differentiation of the uncinate and occipitofrontal fasciculi (i.e., fibers that travel ventrally belong to the uncinate fasciculus whereas those traveling dorsally are occipitofrontal fibers).ConclusionsThe frontal terminations of the uncinate fasciculus were consistently documented to project to the posterior orbitofrontal area. The area of the insular apex is introduced for the first time as a crucial surface landmark to effectively distinguish the stems of the uncinate and occipitofrontal fasciculi. This finding could refine the spatial resolution of awake subcortical mapping, especially for insular lesions, and improve the accuracy of in vivo diffusion tensor imaging protocols.Copyright © 2021 Elsevier Inc. All rights reserved.

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