3 y/o atlanto-occipital dislocation (Case #403)

• Medical Probability: 7 / 10
• Medical Error Summary: Inadequate information is given in the summary. There is a clear protocol for clearance of the cervical spine in the pediatric trauma patient. https://publications.aap.org/pediatrics/article/144...
• Causation Probability: 8 / 10
• Causation Summary: See above. If there was a failure to clear the cervical spine, there is clear causation. If this is an unfortunate sequence, one could make the argument that the trauma of the code itself led to...
• Expert Summary: Double board certified(adult and pediatric) neurosurgeon, currently working in Level I trauma center, who has published chapters on the management of pediatric neurotrauma, and case reports on AOD, sp...
• Similar Summary: Similar cases as in pediatric trauma requiring clearance of the cervical spine, daily(and have been practicing 30 years). Similar as in AOD causing death, only in the immediate trauma setting(codin...

**PEDIATRIC NS EXPERT REQUESTED** Malpositioned ventricular stent leading to neuro deficit. (Case #461)

• Medical Probability: 9 / 10
• Medical Error Summary: The question is going to be, who is responsible for which medical error. In the summary, multiple medical errors are discussed. I will suggest that the neurosurgical error(malposition of the stent) ...
• Causation Probability: 9 / 10
• Causation Summary: Again, you will have people pointing fingers at multiple specialists. There were multiple issues with the original stent placement(switching from a ventricular catheter with a diameter of 2-3mm to ...
• Expert Summary: Double board certified in adult and pediatric neurosurgery. Ran the Florida Center for Chiari Care for years
• Similar Summary: Chiari-several times/week Redo Chiari - monthly Redo Chiari in which I place a stent(or in a patient who already has a stent) - never. 4th ventricular stents are rare procedures, working in a d...

Looking for a pediatric neurosurgeon (Case #517)

• Medical Probability: 9 / 10
• Medical Error Summary: Some general numbers. Pediatric VPS infection rate is 6-8% nationally, with a 6-12 months failure rate of about 40%. shunt are imperfect devices(which is why other treatments are tried, eg choroid p...
• Causation Probability: 10 / 10
• Causation Summary: The child herniated. The treating MD identified the issue and emergently placed an EVd but did so too late. Their own actions confirm cause and effect.
• Expert Summary: 30+ years experience. Senior most continuously practicing pediatric neurosurgeon in TX. Most of us do not testify against other board certified pediatric neurosurgeons
• Similar Summary: This is amongst the most common issues within pediatric neurosurgery. We see shunt failures(at least as a rule out) weekly. Hopefully, we never let it go to herniation.

19yo male VP Shunt Failure Resulting in Death (Case #525)

• Medical Probability: 9 / 10
• Medical Error Summary: The key is going to be who actually saw the patient and what imaging he had. 19yo is a no man's land, transitioning from pediatric to adult neurosurgery. Was he seen by an adult neurosurgeon, with w...
• Causation Probability: 10 / 10
• Causation Summary: Yes. He died of shunt failure, confirmed by autopsy. This is the easy part. The more difficult part is confirming the neurosurgeon missed the diagnosis, as discussed briefly above.
• Expert Summary: At a minimum, you want someone who frequently deals with similar issues. I would strongly suggest an expert who is board certified in pediatric neurosurgery. That list can be found at www.abpns.org....
• Similar Summary: weekly. This is the bread and butter of pediatric neurosurgery.

Surgeon performed a C7-T1 fusion that was not consented to by the patient. (Case #550)

• Medical Probability: 9 / 10
• Medical Error Summary: The surgeon admitted the error, the images confirm the error.
• Causation Probability: 6 / 10
• Causation Summary: There is a high failure rate of these multi-level fusion cases. Surgeon clearly documents his intra-operative concerns and reason to proceed with the fusion(after recounting the levels). Patient siz...
• Expert Summary: Board certified neurosurgeon who has taken trauma call at a level 1 trauma center for decades
• Similar Summary: Cervical fusion cases are frequent(at least weekly). Wrong level operations, rare(I have never cared for any).

27-year-old female w/ pseudotumor cerebri - Shunt failure. (Case #551)

• Medical Probability: 10 / 10
• Medical Error Summary: These are very complicated patients. There are national discussion concerning whether to use shunts and, if so, what kind(lumbo-peritoneal vs ventriculo-peritoneal). Once you place a CERTAS valve in...
• Causation Probability: 10 / 10
• Causation Summary: Cerebral Perfusion Pressure(CPP) = Mean Arterial pressure - Intracranial pressure(ICP) - Central Venous pressure(CVP). This higher either ICP or CVP go, the less blood is getting into the brain(the l...
• Expert Summary: I'm a double board certified(adult and pediatric) neurosurgeon who performs many shunts, including on patients with IIH. I have a 30+ year career caring for similar patients. In 2014, Florida Neuro...
• Similar Summary: I treat IIH weekly(many just for routine follow-up), place 3-5 shunts annually for IIH, and evaluate 6-10 for IIH(meaning, either see them prior to shunt, or have admissions for head-ache in the setti...

Spinal cord compression and irreversible nerve damage from cauda equina syndrome. (Case #552)

• Medical Probability: 10 / 10
• Medical Error Summary: If his Eliquis was never stopped, that would be a deviation of care, clearly documented in the literature. There should also have been some time for him to be off Eliquis prior to resuming it post-op...
• Causation Probability: 10 / 10
• Causation Summary: He had a hematoma, with symptoms, requiring emergent surgery.
• Expert Summary: Have covered a trauma center, in which I take neurosurgery and spine call, for 30+ years.
• Similar Summary: We get a weekly caudal equine call from the ER(they know it will get us there immediately). Most are not real. Most are simply to get the after hours MRI. I don't think I have ever had an outside n...

LLE weakness and left foot drop after spinal cord stimulator replacement with thoracic cord/dural injury. (Case #570)

• Medical Probability: 10 / 10
• Medical Error Summary: The CSF leak/spinal cord injury was not the intended outcome. I'm going to suggest your question is limited. There was clearly a medical error. I do not think it rises to the level of a deviati...
• Causation Probability: 10 / 10
• Causation Summary: She had new symptoms after surgery, with MRI confirmation of injury at the level of her surgery
• Expert Summary: 30+ year history of taking neurosurgical/spinal trauma call at trauma centers. I like the techie stuff(aerospace engineer undergrad), with an interest in neuro-modulation(SCS, pain pumps)
• Similar Summary: We take care of spinal cord stimulators weekly. I have never seen a permanent neurological deficit from these cases(but every time I have to replace the leads, I ask the resident why I allowed them t...