Neurosurgery Experts: A Litigation Guide

Anjelica Cappellino, J.D.

Written by
— Updated on August 10, 2021

Neurosurgery Experts: A Litigation Guide

Neurosurgery Experts: A Litigation Guide

There are few personal injury claims more complex than those dealing with damages to the neurological system. Neurological damages can result from accidents or acts of medical negligence, forming the basis of potential legal claims. Likewise, with over 100 million Americans (close to a third of the population) suffering from neurological diseases, it is no surprise that neurosurgeons are in high demand. Neurosurgeons also face the highest probability of medical malpractice claims, with one out of five physicians, or approximately 20%, facing a lawsuit each year.  Whether a lawsuit claims neurological damage resulting from an accident (i.e., an automobile collision) or alleges medical malpractice against the neurosurgeon himself, an expert in neurosurgery is vital to any case involving this highly complex subject matter.

Who is a Neurosurgery Expert?

Neurology is a medical specialty that treats conditions affecting the brain and nervous system, including the spinal cord, blood vessels, muscles, and nerves. Neurological disorders cover an array of different conditions such as “headaches, sleep disorders, tremors, epilepsy, brain and spinal cord injuries, brain tumors, strokes, Alzheimer’s disease, Parkinson’s disease, multiple sclerosis (MS), amyotrophic lateral sclerosis (ALS), and peripheral nerve disorders.” There are two general types of physicians in neurology – neurologists and neurosurgeons. Neurologists specialize in the diagnosis, treatment, and management of neurological disorders. They utilize a variety of diagnostic tools such as electroencephalograms (EEG), magnetic resonance imaging (MRI), and computer-assisted tomography (CAT) scans.

Neurosurgeons, on the other hand, have similar training, but also specialize in the surgical treatment of these conditions. Neurosurgeons can perform a number of different surgeries related to the neurovascular system – in other words, anything related to the brain, spinal cord, and blood and lymphatic systems. Common surgeries and treatments performed by neurosurgeons include:

Aneurysm Repair

An aneurysm occurs when an artery weakens and cannot maintain pressure against the flow of blood. The artery may begin to bulge or swell, and if it becomes too large, it can rupture. Neurosurgeons can repair aneurysms before and sometimes after they rupture. Brain aneurysms have a relatively high prevalence in the United States – with an estimated 6 million people suffering from an unruptured brain aneurysm. About 40% of ruptured brain aneurysms result in fatalities, with 66% of survivors suffering from permanent neurological deficits. Congenital abnormalities or traumatic brain injuries may cause aneurysms.

Craniotomy or Craniectomy

If the brain needs to be accessed for surgery, a neurosurgeon may perform a craniotomy or craniectomy. These procedures involve the removal of an area of the skull (the cranium). During a craniotomy, the removed bone flap is replaced with plates and screws. If it is not replaced, the procedure is referred to as a craniectomy. These procedures are performed to remove brain tumors, to treat hematomas (blood clots) or infection, to repair aneurysms, or to remove foreign objects.

Spinal Surgery

Neurosurgeons do not only operate on the brain. They also perform a number of surgeries related to the spine. Oftentimes, the spinal discs, which are made of connective tissue and allow for the body’s movement, can become weakened or damaged due to trauma or injury. Neurosurgeons can perform surgery to correct or remove the discs. A spinal tap (also referred to as a lumbar puncture) is a very common procedure during which the surgeon extracts fluid from the spinal column for diagnostic purposes. A spinal tap may also be used to administer medication into the area.

Vascular Surgery

Because neurosurgeons are trained to treat conditions affecting the lymphatic system, they also perform surgeries on blood vessels. Most commonly, these surgeries involve the insertion of a stent in the affected area to help relieve the obstruction of blood flow or the reconstruction of the vessel.

Testimony Provided by Neurosurgery Experts

Depending upon the particular case, it might not always be obvious that a neurosurgery expert is needed to establish injuries. This can be attributed to the fact that neurological injuries are notoriously silent.

For example, traumatic brain injuries are a common (and serious) result of accidents involving an impact to the head, such as car accidents. However, symptoms may not be immediately apparent. If you are representing a plaintiff in any type of accident during which they may have sustained a hit or impact on their head, it is wise to have a thorough neurological examination conducted. Treatment may be needed, which can range in severity, from therapy to brain surgery. By retaining an experienced neurological expert at the outset, medical records can be reviewed and reports can be drafted along the way of the plaintiff’s treatment.  A qualified expert should be able to attest to the plaintiff’s condition, the proximate cause, the necessity of treatment, and the extent of damages due to the brain injury.

Brain injuries can result in severe injuries and high settlements. This past week, the city of Seattle and its insurers paid a record $65 million to the family of an attorney who suffered a traumatic brain injury when her car collided with a Seattle Fire Department ambulance. The plaintiff, who was once a successful litigator, now requires 24-hour care due to the extensive injuries suffered in the accident. This is the largest personal injury settlement in the city’s history.

Medical Malpractice Claims

With neurosurgeons facing the highest probability of medical malpractice lawsuits, neurosurgery experts are frequently needed to prove (or defend) these cases.  As in any medical malpractice action, the expert should be able to define the requisite standard of care within the profession and state how the defendant doctor either deviated from (or in the case of a defense expert, maintained) the standard of care when treating the plaintiff patient. Further, whether the deviation proximately caused the injury is of particular importance in light of the inherent complexities of neurosurgery.

In a study conducted on neurosurgeon malpractice claims spanning a 31-year period, causes of action related to the spine (58%) make up the majority, with general neurosurgery (15.7%) and cerebrovascular (i.e., relating to the brain and blood vessels) procedures (11.1%) as the second- and third-most cited claims. The three most frequently cited allegations against the neurosurgeons were procedural errors, failure to treat, and failure to diagnose. Approximately 19% of cases involved the death of the patient. While very few cases go to trial, a defendant’s verdict was reached in 48.1% of the cases studied. When a plaintiff verdict was reached, the payouts ranged widely, from $80,000 to over $216 million.

In a very recent malpractice case, the Texas Supreme Court ruled in favor of a Houston woman whose husband died as a result of his neurosurgeon’s misdiagnosis.  Her husband suffered from fluid in the brain (a treatable condition) but the physician failed to diagnose it resulting in the patient’s death in 2010. Relying upon the expert testimony, the jury rendered a $4.2 million verdict in favor of the plaintiff. Although the First Court of Appeals in Houston overturned the jury verdict and rejected plaintiff’s expert witness, the Supreme Court found that the appellate court was in error and that the jury was entitled to rely on the expert’s opinion.

Overall, whether litigating a medical malpractice action or a common negligence claim, any injury that involves the neurological system can benefit from a qualified neurosurgery expert to testify to the complexities of the specialty.

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