Does the superior fronto-occipital fascicle exist in the human brain? Fiber dissection and brain functional mapping in 90 patients with gliomas

The presence of the superior fronto-occipital fascicle (SFOF) has been reported in the Rhesus monkey; however, it is a subject of controversy in humans. The aim of this study is to identify the SFOF using both in vitro and in vivo anatomo-functional analyses. This study consisted of two approaches. First, one acallosal brain and 12 normal postmortem hemispheres (five left and seven right sides) were dissected under a microscope using Klingler's fiber dissection technique. We focused on the medial subcallosal area superior to the Muratoff bundle, which has been indicated as a principal target area of the SFOF in previous studies. Second, 90 patients underwent awake craniotomy for gliomas with direct electrical stimulations. Functional examinations for visual, ataxic, and cognitive tasks were performed and 453 positive mapping sites were investigated by voxel-based morphometry analysis to establish the functions of the SFOF. The corticostriatal fibers, or the Muratoff bundle, and thalamic peduncle fibers joined in the area of the caudate nucleus, making thalamic peduncle/ corticostriatal bundles, which ran antero-posteriorly in the anterior subcallosal area and radiated from the caudate superior margin in the posterior subcallosal area. However, no SFOF fiber bundle crossed perpendicular to the thalamic peduncle/ corticostriatal bundles in the posterior subcallosal area. In the acallosal hemispheres, Probst bundles were confirmed and the subcallosal areas did not show a specific organization different from the normal brain. Hence, we could not detect a long and continuous association fascicle connecting the frontal lobe and occipital or parietal lobe in the target areas. Furthermore, in the in vivo functional mappings of awake surgery and voxel-based morphometry analysis, eight positive points on the SFOF were selected from the total 453 positive points, but their functions were not related with visual processing and spatial awareness, as has been reported in previous studies. In conclusion, in the present study we attempted to investigate the existence of the SFOF using an anatomical and functional approach. According to our results, the SFOF may not exist in the human brain.