Structural and functional alterations in the contralateral hemisphere following pediatric intracranial surgery: a pilot longitudinal neuroimaging study

Our findings suggest that post-craniotomy structural and functional brain changes in children follow a subcortical-to-cortical trajectory, with structural alterations (decreased gray matter density) preceding functional activation. This process demonstrates progressive and cumulative characteristics. These modifications appear to correlate with cognitive function recovery and may represent potential mechanisms underlying spontaneous cognitive rehabilitation in pediatric patients post-surgery. Cautiously interpreted, the deeper neuroplastic mechanisms underlying these changes might involve synaptic pruning-like processes induced by external perturbation.