Courthouses and Craniotomies: Medical Malpractice Indemnity Payments and Litigation Verdicts in Skull Base and Open Cerebrovascular Neurosurgical Practice in the United States throughout the 21st Century

Abstract

Background

This work offers analysis of lawsuits associated with skull base and open cerebrovascular pathologies in the past 24 years using Westlaw Edge legal database.

Methods

Litigation outcome possibilities were either jury verdicts in favor of the plaintiff (patient) or defendant (physician), or settlement. US circuit courts were utilized for geographical analysis.

Results

Overall, a defense verdict was awarded in 57.1% of cases (n = 48) while a plaintiff verdict was awarded in 33.3% of cases (n = 28). Settlement occurred in 9.5% of cases analyzed, with no significant difference in amount paid compared with plaintiff verdicts ($1.3 [IQR: 0.4–3.99] million versus $2 [IQR: 1–6.75] million, respectively; p = 0.73).

Conclusion

Most malpractice cases (53.6%) involved aneurysmal pathology, followed by skull base tumors (23.8%). Claims were most commonly against neurological surgery specialty (41.7%) and radiology (15.5%). US circuit 9 had the highest number of cases (22/84, 26.2%), with a majority occurring in California (n = 16). The total amount owed from cases resulting in plaintiff verdict or settlement totaled to $171,387,558 with a median of $2,000,000 (IQR: 1,000,000–6,650,000). The highest per single case paid to the plaintiff was $49,000,000 (New York). There was no significant association between the geographical circuit and the median amount paid (p = 0.42).

Keywords

skull base - cerebrovascular - litigation - malpractice

Note

This work was submitted for presentation at the annual NASBS conference in New Orleans, LA.

Publikationsverlauf

Eingereicht: 17. Juni 2025

Angenommen: 02. September 2025

Accepted Manuscript online:
04. September 2025

Artikel online veröffentlicht:
16. September 2025

• References

• 1 Jena AB, Seabury S, Lakdawalla D, Chandra A. Malpractice risk according to physician specialty. N Engl J Med 2011; 365 (07) 629-636
• 2 Larkin CJ, Roumeliotis AG, Karras CL. et al. Overview of medical malpractice in neurosurgery. Neurosurg Focus 2020; 49 (05) E2
• 3 Hyman DA, Lerner J, Magid DJ, Black B. Association of past and future paid medical malpractice claims. JAMA Health Forum 2023; 4 (02) e225436
• 4 Sage WM, Boothman RC, Gallagher TH. Another medical malpractice crisis?: Try something different. JAMA 2020; 324 (14) 1395-1396
• 5 Scholz M, Parvin R, Thissen J, Löhnert C, Harders A, Blaeser K. Skull base approaches in neurosurgery. Head Neck Oncol 2010; 2: 16
• 6 Gerstl JVE, Gupta S, Stenberg CE. et al. From operating room to courtroom: analyzing malpractice trajectories in cranial neurosurgery. Neurosurgery 2025; 96 (01) 205-212
• 7 Medress ZA, Jin MC, Feng A, Varshneya K, Veeravagu A. Medical malpractice in spine surgery: a review. Neurosurg Focus 2020; 49 (05) E16
• 8 Murff HJ, France DJ, Blackford J. et al. Relationship between patient complaints and surgical complications. Qual Saf Health Care 2006; 15 (01) 13-16
• 9 Newman-Toker DE, Schaffer AC, Yu-Moe CW. et al. Serious misdiagnosis-related harms in malpractice claims: the “Big Three”—vascular events, infections, and cancers. Diagnosis (Berl) 2019; 6 (03) 227-240 Erratum in: Diagnosis (Berl). 2020 May 16;8(1):127–128. doi: 10.1515/dx-2020-0034. PMID:31535832
• 10 Pallocci M, Treglia M, Passalacqua P. et al. Informed consent: legal obligation or cornerstone of the care relationship?. Int J Environ Res Public Health 2023; 20 (03) 2118
• 11 Studdert DM, Spittal MJ, Zhang Y, Wilkinson DS, Singh H, Mello MM. Changes in practice among physicians with malpractice claims. N Engl J Med 2019; 380 (13) 1247-1255
• 12 Studdert DM, Bismark MM, Mello MM, Singh H, Spittal MJ. Prevalence and characteristics of physicians prone to malpractice claims. N Engl J Med 2016; 374 (04) 354-362
• 13 Tang OY, Hartnett DA, Hays SB, Syed S, Daniels AH. Determinants of brain tumor malpractice litigation outcome and indemnity payments: a 29-year nationwide analysis. Neurosurg Focus 2020; 49 (05) E21
• 14 Baicker K, Fisher ES, Chandra A. Malpractice liability costs and the practice of medicine in the Medicare program. Health Aff (Millwood) 2007; 26 (03) 841-852
• 15 Bekelis K, Missios S, Wong K, MacKenzie TA. The practice of cranial neurosurgery and the malpractice liability environment in the United States. PLoS One 2015; 10 (03) e0121191
• 16 Elijovich L, Higashida RT, Lawton MT, Duckwiler G, Giannotta S, Johnston SC. Cerebral Aneurysm Rerupture After Treatment (CARAT) Investigators. Predictors and outcomes of intraprocedural rupture in patients treated for ruptured intracranial aneurysms: the CARAT study. Stroke 2008; 39 (05) 1501-1506
• 17 McClellan FM, White III AA, Jimenez RL, Fahmy S. Do poor people sue doctors more frequently? Confronting unconscious bias and the role of cultural competency. Clin Orthop Relat Res 2012; 470 (05) 1393-1397