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

This work offers analysis of lawsuits associated with skull base and open cerebrovascular pathologies in the past 24 years using WestLaw legal database. 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. 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 to plaintiff verdicts [$1.3 (IQR: 0.4-3.99) million vs. $2 (IQR: 1-6.75) million, respectively. p= 0.73]. 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).