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To date, postsurgery neuroplastic changes supporting behavioral recovery after left or right hemispherotomy remain unclear. In the present study, we systematically investigated changes in gray matter volume (GMV) before and after surgery and further analyzed their relationships with behavioral scores in two large groups of pediatric patients with left and right hemispherotomy (29 left and 28 right). To control for the dramatic developmental effect during this stage, age\u2010adjusted GMV within unaffected brain regions was derived voxel by voxel using a normative modeling approach with an age\u2010matched reference cohort of 2115 healthy children. Widespread GMV increases in the contralateral cerebrum and ipsilateral cerebellum and GMV decreases in the contralateral cerebellum were consistently observed in both patient groups, but only the left hemispherotomy patients showed GMV decreases in the contralateral cingulate gyrus. Intriguingly, the GMV decrease in the contralateral cerebellum was significantly correlated with improvement in behavioral scores in the right but not the left hemispherotomy patients. Importantly, the preoperative voxelwise GMV features can be used to significantly predict postoperative behavioral scores in both patient groups. These findings indicate an important role of the contralateral cerebellum in the behavioral recovery following right hemispherotomy and highlight the predictive potential of preoperative imaging features in postoperative behavioral performance.<\/jats:p>","DOI":"10.1002\/hbm.70020","type":"journal-article","created":{"date-parts":[[2024,9,3]],"date-time":"2024-09-03T10:25:31Z","timestamp":1725359131000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":7,"title":["Behavioral and brain morphological changes before and after hemispherotomy"],"prefix":"10.1002","volume":"45","author":[{"given":"Hao","family":"Yu","sequence":"first","affiliation":[{"name":"Pediatric Epilepsy Center Peking University First Hospital  Beijing China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yijun","family":"Chen","sequence":"additional","affiliation":[{"name":"State Key Laboratory of Cognitive Neuroscience and Learning &amp; 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