Cortical hypertrophy of the contralateral hemisphere after hemispherotomy in children with Sturge-Weber syndrome: A longitudinal volumetric study.
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OBJECTIVE: This study was undertaken to investigate the longitudinal volumetric changes of the contralateral hemisphere following hemispherotomy in patients with Sturge-Weber syndrome (SWS) and to evaluate their association with neurodevelopmental outcomes. METHODS: We retrospectively analyzed 33 pediatric patients with SWS who underwent hemispherotomy and had at least one follow-up magnetic resonance imaging (MRI) at 6, 12, or 24 months postoperatively. Cortical volume of the contralateral (nonsurgical) hemisphere was measured on 3-T MRI using SPM12 segmentation, and the volumetric increase rate was calculated. Associations between cortical volume and clinical factors, including age at surgery and seizure outcome, were examined using a linear mixed-effects model. We evaluated the relationships between the cortical volume of the contralateral hemisphere and the acquisition of neurodevelopmental milestones (standing, walking, single words, and sentences). Healthy age- and sex-matched controls (n = 22) were included for comparison. RESULTS: Contralateral cortical volume significantly increased over time following hemispherotomy (p < .01). Earlier hemispherotomy was associated with greater volumetric growth (p < .001), independent of patient age at postoperative MRI acquisition. Patients with larger age-adjusted cortical volumes exhibited earlier acquisition of standing and walking (ρ = -.70 and -.63, respectively). No significant correlation was observed between cortical hypertrophy and seizure outcome. SIGNIFICANCE: This study demonstrates that the contralateral hemisphere undergoes time-dependent hypertrophy following hemispherotomy in patients with SWS. Early hemispherotomy may enhance this structural plasticity and contribute to improved neurodevelopmental outcomes. Longitudinal volumetric analysis of the contralateral hemisphere may serve as a surrogate biomarker of structural reorganization and a valuable tool to guide the optimal timing of surgical intervention in this population.