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Objective: Neurosurgeons are known as a high-risk group for malpractice litigation in western countries. Besides, based on our previously reported study, neurosurgeons are also in a high-risk group in Japan. Increasing risk of malpractice litigation is a big problem in Japanese healthcare system and several court decisions related to the neuroendovascular procedures are known. Herein, we reviewed the past court decisions regarding the neuroendovascular procedures and investigated the factors affected to the court decisions focusing on the prevention of allegations. Methods: Court decisions related to neuroendovascular procedures between 2001 and 2015 were extracted from the database in Courts in Japan, and the reasons for the decisions were explored in each case. Results: Ten cases regarding the neuroendovascular procedures were found among 446 retrieved healthcare-related court decisions. Five out of those 10 cases were attributed to the embolization of unruptured aneurysms, two were correlated with the embolization of arteriovenous malformations (AVMs), one was related to the carotid stenting, and two were associated with the diagnostic angiography. Negligence was identified in five out of the 10 cases, and dismissed in the other five cases. In the five court decisions in favor of plaintiffs, one identified negligence in clinical decisions, one in technical skills, and three in process of informed consent. In one case, defendants could not prove their contentions in technical skills for absence of intraprocedural video records and negligence was confirmed. In two out of five court decisions in favor of the defendant, the claim was dismissed based on the well-described clinical records or documents pertaining to the informed consent. Conclusion: Neuroendovascular procedures are one of the high-risk groups for malpractice litigation. Sufficient informed consent, documentation, and storage of the clinical data are indispensable prerequisites to reduce the risk of malpractice litigation.

Detailed Investigation of the Court Decisions against Neuroendovascular Therapy from the Disclosed Database by Courts in Japan