Sex differences in neuroplasticity and functional recovery after neurosurgical interventions

OBJECTIVE: To analyze modern data on the influence of biological sex and gender factors on mechanisms of neuroplasticity and functional recovery after neurosurgical interventions. MATERIAL AND METHODS: We reviewed the databases (PubMed, Scopus, Russian Science Citation Index (RSCI) and Google Scholar) over the past 10 years. The review covers clinical trials, prospective and retrospective cohort studies and animal models of traumatic brain injury, surgery for brain cancer, vascular accidents and spinal cord injury. The main parameters were diffusion tensor imaging data, functional MRI, hormonal profile and standardized clinical scales including the modified Rankin scale, Barthel index, ASIA and FIM scales. RESULTS: Female brain has better interhemispheric connectivity that provides adaptive advantage in focal lesions of dominant hemisphere. Male brain is optimized for intrahemispheric signaling promoting faster motor coordination. Estrogens and progesterone have neuroprotective effect through modulation of inflammatory response and support of myelination, but this effect depends on age and phase of reproductive cycle. In clinical practice, women often demonstrate lower rates of functional independence at discharge after stroke due to comorbidity and social factors, despite equal or superior potential for neurological recovery compared to men. CONCLUSION: Biological sex is a critical determinant of neurosurgical outcomes. Discrepancy between biological recovery potential (higher in women) and actual functional outcomes (often better in men) highlights the need to develop personalized, gender-specific rehabilitation protocols taking into account specifics of connectome and hormonal backgrounds.