Yan Na, Hu Bohan, Zhai Huina, Han Xu, Hu Cuiling, Guan Xueyi, Gong Jian
Department of Neurology, Peking University Shougang Hospital, Beijing, China.
Department of Pediatric Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
Front Hum Neurosci. 2025 Mar 7;19:1568945. doi: 10.3389/fnhum.2025.1568945. eCollection 2025.
Intracranial space-occupying lesions (ISOLs) are common pediatric conditions. Recent therapeutic advances have significantly improved survival rates, necessitating increased attention to post-operative cognitive outcomes, which are crucial determinants of patients' quality of life.
While previous studies have predominantly focused on short-term post-operative changes, this study aimed to investigate longitudinal changes in cognition, brain structure, and function of the contralateral hemisphere following pediatric neurosurgery.
Nineteen pediatric patients with ISOLs were enrolled in a paired design study. Cognitive assessments, structural imaging, and functional imaging data were collected at three time points: pre-operation, first post-operative follow-up (mean 75 days pre-operation), and second post-operative follow-up (mean 316 days pre-operation). Relevant metrics were computed and compared across time points.
The majority of cognitive domains exhibited a gradual longitudinal improvement trajectory, with three domains showing significant enhancement at the second follow-up compared to preoperative baseline: cognitive flexibility ( = 4.201, = 0.001), executive function ( = 3.478, = 0.003), and social accuracy ( = 3.248, = 0.004). The contralesional hemisphere demonstrated alterations primarily characterized by gray matter density reduction, progressing from subcortical structures (first follow-up: thalamus, peak intensity = -7.54, cluster < 0.016) to cortical regions (second follow-up compared to previous follow-up: superior frontal gyrus, peak intensity = -7.80, cluster < 0.016), followed by a subsequent increase in brain activity power of smaller magnitude (second follow-up: medial superior frontal gyrus, amplitude of low frequency fluctuation, peak intensity = 5.96, cluster < 0.016). Correlation analysis suggests that there is an association between changes in brain structure and alterations in cognitive function ( = -0.53, = 0.019).
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.
颅内占位性病变（ISOLs）是常见的儿科疾病。近期治疗进展显著提高了生存率，因此需要更加关注术后认知结果，这是患者生活质量的关键决定因素。
虽然先前的研究主要集中在术后短期变化，但本研究旨在调查小儿神经外科手术后对侧半球认知、脑结构和功能的纵向变化。
19例患有ISOLs的儿科患者纳入配对设计研究。在三个时间点收集认知评估、结构成像和功能成像数据：术前、首次术后随访（平均术前75天）和第二次术后随访（平均术前316天）。计算并比较各时间点的相关指标。
大多数认知领域呈现出逐渐纵向改善的轨迹，与术前基线相比，三个领域在第二次随访时显示出显著增强：认知灵活性（t = 4.201，p = 0.001）、执行功能（t = 3.478，p = 0.003）和社交准确性（t = 3.248，p = 0.004）。对侧半球表现出主要以灰质密度降低为特征的改变，从皮质下结构（首次随访：丘脑，峰值强度 = -7.54，聚类p < 0.016）发展到皮质区域（第二次随访与前次随访相比：额上回，峰值强度 = -7.80，聚类p < 0.016），随后是较小幅度的脑活动功率增加（第二次随访：额上回中部，低频波动幅度，峰值强度 = 5.96，聚类p < 0.016）。相关分析表明，脑结构变化与认知功能改变之间存在关联（r = -0.53，p = 0.019）。
我们的研究结果表明，儿童开颅术后脑结构和功能变化遵循从皮质下到皮质的轨迹，结构改变（灰质密度降低）先于功能激活。这一过程具有渐进性和累积性特征。这些改变似乎与认知功能恢复相关，可能代表小儿患者术后自发认知康复的潜在机制。谨慎解读的话，这些变化背后更深层次的神经可塑性机制可能涉及外部扰动诱导的类似突触修剪的过程。
