{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,13]],"date-time":"2026-06-13T14:05:22Z","timestamp":1781359522433,"version":"3.54.1"},"reference-count":64,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"3","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2021,9]]},"abstract":"\n OBJECTIVE<\/jats:title>\n Motor cortical dysfunction has been shown to be reversible in patients with unilateral atherosclerotic disease after cerebral revascularization. Moyamoya vasculopathy (MMV) is a rare bilateral stenoocclusive cerebrovascular disease. The aim of this study was to analyze the corticospinal excitability and the role of bypass surgery in restoring cortical motor function in patients by using navigated transcranial magnetic stimulation (nTMS).<\/jats:p>\n <\/jats:sec>\n \n METHODS<\/jats:title>\n Patients with bilateral MMV who met the criteria for cerebral revascularization were prospectively included. Corticospinal excitability, cortical representation area, and intracortical inhibition and facilitation were assessed by nTMS for a small hand muscle (first dorsal interosseous) before and after revascularization. The clinically and\/or hemodynamically more severely affected hemisphere was operated first as the leading hemisphere. Intra- and interhemispheric differences were analyzed before and after direct or combined revascularization.<\/jats:p>\n <\/jats:sec>\n \n RESULTS<\/jats:title>\n A total of 30 patients with bilateral MMV were examined by nTMS prior to and after revascularization surgery. The corticospinal excitability was higher in the leading hemisphere compared with the non-leading hemisphere prior to revascularization. This hyperexcitability was normalized after revascularization as demonstrated in the resting motor threshold ratio of the hemispheres (preoperative median 0.97 [IQR 0.89\u20131.08], postoperative median 1.02 [IQR 0.94\u20131.22]; relative effect = 0.61, p = 0.03). In paired-pulse paradigms, a tendency for a weaker inhibition of the leading hemisphere was observed compared with the non-leading hemisphere. Importantly, the paired paradigm also demonstrated approximation of excitability patterns between the two hemispheres after surgery.<\/jats:p>\n <\/jats:sec>\n \n CONCLUSIONS<\/jats:title>\n The study results suggested that, in the case of a bilateral chronic ischemia, a compensation mechanism between both hemispheres seemed to exist that normalized after revascularization surgery. A potential role of nTMS in predicting the efficacy of revascularization must be further assessed.<\/jats:p>\n <\/jats:sec>","DOI":"10.3171\/2021.6.focus21280","type":"journal-article","created":{"date-parts":[[2021,9,1]],"date-time":"2021-09-01T07:38:55Z","timestamp":1630481935000},"page":"E7","source":"Crossref","is-referenced-by-count":5,"title":["Motor excitability in bilateral moyamoya vasculopathy and the impact of revascularization"],"prefix":"10.3171","volume":"51","author":[{"given":"Gueliz","family":"Acker","sequence":"first","affiliation":[{"name":"Charit\u00e9\u2013Universit\u00e4tsmedizin Berlin, corporate member of Freie Universit\u00e4t Berlin and Humboldt-Universit\u00e4t zu Berlin, Department of Neurosurgery, Berlin;"},{"name":"Berlin Institute of Health at Charit\u00e9\u2013Universit\u00e4tsmedizin Berlin, Berlin;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Davide","family":"Giampiccolo","sequence":"additional","affiliation":[{"name":"Charit\u00e9\u2013Universit\u00e4tsmedizin Berlin, corporate member of Freie Universit\u00e4t Berlin and Humboldt-Universit\u00e4t zu Berlin, Department of Neurosurgery, Berlin;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kerstin","family":"Rubarth","sequence":"additional","affiliation":[{"name":"Berlin Institute of Health at Charit\u00e9\u2013Universit\u00e4tsmedizin Berlin, Berlin;"},{"name":"Charit\u00e9\u2013Universit\u00e4tsmedizin Berlin, corporate member of Freie Universit\u00e4t Berlin and Humboldt-Universit\u00e4t zu Berlin, Institute of Biometry and Clinical Epidemiology, Berlin;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert","family":"Mertens","sequence":"additional","affiliation":[{"name":"Charit\u00e9\u2013Universit\u00e4tsmedizin Berlin, corporate member of Freie Universit\u00e4t Berlin and Humboldt-Universit\u00e4t zu Berlin, Department of Neurosurgery, Berlin;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anna","family":"Zdunczyk","sequence":"additional","affiliation":[{"name":"Charit\u00e9\u2013Universit\u00e4tsmedizin Berlin, corporate member of Freie Universit\u00e4t Berlin and Humboldt-Universit\u00e4t zu Berlin, Department of Neurosurgery, Berlin;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Juliane","family":"Hardt","sequence":"additional","affiliation":[{"name":"Charit\u00e9\u2013Universit\u00e4tsmedizin Berlin, corporate member of Freie Universit\u00e4t Berlin and Humboldt-Universit\u00e4t zu Berlin, Institute of Biometry and Clinical Epidemiology, Berlin;"},{"name":"University of Applied Sciences Hannover, Hochschule Hannover\u2014University of Applied Sciences and Arts, Fakult\u00e4t III, Department Information and Communication, Medical Information Management, Hannover;"},{"name":"Department of Biometry, Epidemiology and Information Processing, WHO Collaborating Centre for Research and Training for Health in the Human-Animal-Environment Interface, University of Veterinary Medicine Hannover, Foundation, Hannover; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel","family":"Jussen","sequence":"additional","affiliation":[{"name":"Charit\u00e9\u2013Universit\u00e4tsmedizin Berlin, corporate member of Freie Universit\u00e4t Berlin and Humboldt-Universit\u00e4t zu Berlin, Department of Neurosurgery, Berlin;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Heike","family":"Schneider","sequence":"additional","affiliation":[{"name":"Charit\u00e9\u2013Universit\u00e4tsmedizin Berlin, corporate member of Freie Universit\u00e4t Berlin and Humboldt-Universit\u00e4t zu Berlin, Department of Neurosurgery, Berlin;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tizian","family":"Rosenstock","sequence":"additional","affiliation":[{"name":"Charit\u00e9\u2013Universit\u00e4tsmedizin Berlin, corporate member of Freie Universit\u00e4t Berlin and Humboldt-Universit\u00e4t zu Berlin, Department of Neurosurgery, Berlin;"},{"name":"Berlin Institute of Health at Charit\u00e9\u2013Universit\u00e4tsmedizin Berlin, Berlin;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vera","family":"Mueller","sequence":"additional","affiliation":[{"name":"Charit\u00e9\u2013Universit\u00e4tsmedizin Berlin, corporate member of Freie Universit\u00e4t Berlin and Humboldt-Universit\u00e4t zu Berlin, Department of Neurosurgery, Berlin;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thomas","family":"Picht","sequence":"additional","affiliation":[{"name":"Charit\u00e9\u2013Universit\u00e4tsmedizin Berlin, corporate member of Freie Universit\u00e4t Berlin and Humboldt-Universit\u00e4t zu Berlin, Department of Neurosurgery, Berlin;"},{"name":"Cluster of Excellence: \u201cMatters of Activity. 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