• Alireza Borghei, Ryan Kelly, John J Pearce, Travis R Stoub, and Sepehr Sani.
• Department of Neurosurgery, Rush University Medical Center, Chicago , Illinois , USA.
• Neurosurgery. 2024 Apr 1; 94 (4): 856863856-863.

Background And ObjectivesThe piriform cortex (PC) is part of the primary olfactory network in humans. Recent findings suggest that it plays a role in pathophysiology of epilepsy. Therefore, studying its connectivity can further our understanding of seizure propagation in epilepsy. We aimed to explore the structural connectivity of PC using high-quality human connectome project data coupled with segmentation of PC on anatomic MRI.MethodsTwenty subjects were randomly selected from the human connectome project database, and PC was traced on each hemisphere. Probabilistic whole-brain tractography was then used to visualize PC connectivity.ResultsThe strongest connectivity was noted between PC and ipsilateral insula in both hemispheres. Specifically, the posterior long gyrus of each insula was predominantly connected to PC. This was followed by connections between PC and basal ganglia as well as orbital frontal cortices.ConclusionThe PC has the strongest connectivity with the insula bilaterally. Specifically, the posterior long gyri of insula have the strongest connectivity. This finding may provide additional insight for localizing and treating temporo-insular epilepsy.Copyright © Congress of Neurological Surgeons 2023. All rights reserved.

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