Cerebral Aneurysms in Judicial Precedents

Abstract

ObjectiveFrom November 30, 2016, the Korean Government carried the revised Medical Dispute Mediation and Arbitration Act into effect. Mediation will start automatically without agreements of the defendant, when the outcome of the patient was death, coma more than a month or severe disability. Cerebral aneurysm has a definite risk of bad outcome, especially in the worst condition. Any surgical intervention to this lesion has its own high risk of complications. Recently, Seoul central district court decided 50% responsibility of the doctors who made a rupture of the aneurysm during coiling (2015Ga-Dan5243104). We reviewed judicial precedents related to cerebral aneurysms in lawsuit using a web search.MethodsWe searched judicial precedents at a web search of the Supreme Court, using the key words, "cerebral aneurysm".ResultsThere were 15 precedents, six from the Supreme Court, seven from the High Court, and two from district courts. Seven precedents were related to the causation analysis, such as work-relationship. Five precedents were malpractice suits related bad results or complications. Remaining three precedents were related to the insurance payment. In five malpractice precedents, two precedents of the Supreme Court reversed former two precedents of the High Court.ConclusionJudicial precedents on the cerebral aneurysm included not only malpractice suits, but also causation analysis or insurance payment. Attention to these subjects is needed. We also need education of the independent medical examination. To avoid medical disputes, shared decision making seems to be useful, especially in cases of high risk condition or procedures.

Multimodality techniques in microsurgical clipping as the gold standard treatment in the management of basilar tip aneurysm: A case series

“…Medicolegal implications which are faced by the endovascular specialists due to procedural complications have been a great concern in some of the recent publications. [ 15 ]…”

Institutional experience of microsurgical management in posterior circulation aneurysm

“…Due to procedural complications, some endovascular specialists have to face medico-legal implications. [32] The major disadvantage of endovascular procedures with stent-assisted coiling for basilar top aneurysm and trunk aneurysm is the risk of compromising blood flow to brain stem perforators. A study conducted by Richling et al showed that there is a 92% occlusion rate in basilar bifurcation aneurysm size <10 mm, but in aneurysm size of 10 mm or above, the occlusion rate is 61%.…”

Recanalization of Embolized Endovascular Intracranial Aneurysms and Changes in the Blood Viscosity: A Pilot Study

“…Cerebral aneurysm formation is caused by various factors, including genetic factors such as fibromuscular dysplasia, autosomal dominant polycystic kidney disease, tuberous sclerosis, and arteriovenous malformations (AVM), as well as environmental factors such as smoking and alcohol abuse, and other influence such as atherosclerosis, hypertension, or advanced age [4].…”

“…Studies conducted by epidemiologists have revealed the rate of incidental aneurysms to be 7% (95% confidence interval [CI]) [5][6][7][8][9], with a corresponding occurrence of clinoid segment aneurysms at 3% (95% CI) [2][3][4]. Globally it is estimated to be roughly 3.2%, at an average age of 50 years, and with the overall gender ratio of 1: 1.…”