1114 - Postoperative Brown-Sequard Syndrome Following Elective T3-4 Laminectomy for Ventral CSF Leak Repair: A Case Report

A 66-year-old male was admitted to an acute rehabilitation unit following an elective T3-4 laminectomy and repair of a ventral CSF leak secondary to a chronic osteophyte and mild disc herniation at the T3-T4 interspace. He initially presented to an outside hospital with bilateral hand tremors, tinnitus, hearing loss, ataxia, and orthostatic headaches. Imaging revealed a brain meningioma, infratentorial superficial siderosis, and the ventral CSF leak.
During the surgery, an 8–10 second cardiac pause occurred, accompanied by decreased somatosensory (SSEP) and motor evoked potentials (MEP) in the right lower extremity (RLE), with milder declines in the left lower extremity (LLE). Postoperatively, the patient exhibited classic features of BSS, including RLE weakness and loss of proprioception, sensory loss to pinprick and temperature in the LLE, and complete sensory loss at the right T4 level. Postoperative imaging ruled out infarction or hemorrhage but demonstrated spinal cord edema at the surgical site.

Discussions: BSS is a rare spinal cord injury (SCI), representing 1–4% of traumatic cases. Non-traumatic causes, including postoperative BSS, are exceptionally uncommon, with few reported cases linked to disc herniation or osteophytes. In this case, intraoperative neuromonitoring (SSEP and MEP) detected ischemic compromise but did not fully predict the severity of postoperative neurological deficits. The etiology of BSS in this patient remains unclear, though intraoperative ischemia and postoperative spinal cord edema are possible contributory factors. Early, intensive rehabilitation was critical in motor recovery, enabling the patient to progress from moderate assistance to close supervision for activities of daily living and ambulation with an assistive device.

Conclusions: This case highlights the importance of intraoperative hemodynamic optimization and post-acute rehabilitation in mitigating postoperative neurological deficits and maximizing functional recovery following SCI.