In this medical malpractice case, the defendant, a Board Certified neurosurgeon, diagnosed the plaintiff with Chiari I malformation. This is a genetic malformation of the bones in the back of the brain, which results in increased intra-cranial pressure and related symptoms. It can be treated in a variety of ways, the most dramatic of which is surgery in which part of the bone in the back of the brain is removed, along with and some of the vertebral bodies in the upper part of the neck are removed and fused.
As a result of this diagnosis, he persuaded the plaintiff to undergo neurosurgery of the brain, consisting of a suboccipital craniectomy with a C1 laminectomy and decompression with duraplasty. This surgery later failed (see below), which resulted in a more dramatic and involved salvage surgery, by a world famous brain surgeon who specializes in Chiari malformation surgery.
In connection with the initial surgery’s failure, as performed by the defendant neurosurgeon, the Plaintiff alleged that the surgery was completely unnecessary, since the plaintiff’s symptoms were consistent with increased intra-cranial pressure, following a spinal tap, which was done to see if his symptoms were due to Lyme’s disease. The plaintiff contended that as a result of that spinal tap, there was a continued loss of cerebral spinal fluid, which was the cause of his symptoms, and that in time, with additional blood patches, the condition would resolve. In fact, the plaintiff alleged that the plaintiff did not have Chiari I malformation, but rather, intracranial hypotension, which did not require any surgery.
Our contention was factually supported by the medical chart and the MRI, MRA, and CT scans of the brain, which shows that there never was a radiological diagnosis of Chiari I malformation. In fact, the MRI of the brain, taken at Northern Westchester Hospital, indicates an impression of intracranial hypotension.
The plaintiff’s expert opined, within a reasonable degree of medical certainty, that had the proper differential diagnosis been made, and had the plaintiff been treated for intracranial hypotension, rather than Chiari I malformation, then the cranial decompression surgery would have been unnecessary. Had this surgery not been done, it would not have failed, as it did, and the plaintiff would not have been required to undergo yet a second decompression surgery.
The plaintiff further contended that even if the diagnosis were correct, the procedure itself was fatally flawed. More particularly, the plaintiff contended that the surgeon wrongly chose to use a Duragen Patch for the duraplasty (a synthetic material), to patch the section of the back part of his brain where the bone was removed. The plaintiff contended that this material was fatally flawed for this type of intra-cranial surgery, and that in fact, there was a black box warning, which advised against the use of this product in this type of surgery.
In keeping with what the plaintiff contended were the risks for this type of surgery and for the material that was used, the surgery failed. The plaintiff was therefore required to undergo additional neurosurgery, which consisted of the following: with different surgeons at another medical institution, he underwent a posterior fossa revision consisting of drainage and excision of pseudomeningocele fat extending from the suboccipital to C5; enlargement of suboccipital craniectomy; widening of the narrow C1 laminectomy; C2 laminectomy; excision of partially absorbed Duragen duraplasty patch; untethering of tortuous left posterior inferior cerebellar artery from right dural suture line; microneurolysis of both posterior inferior cerebellar arteries; both cerebellar tonsils; both spinal accessory nerves, and vermis of the cerebellum; bipolar shrinkage of the cerebellar tonsils; expansile duraplasty employing autogenous pericranium; and creation of an extradural blood patch, at the North Shore University Hospital.
As a result of the negligence of these defendants, the plaintiff sustained severe and permanent personal and psychological injuries, including, but not limited to, ringing in both ears; vision changes including blurring of vision; photophobia; halos; light sensitivity; facial numbness; tremors of left arm; paresthesias in both hands and feet; neuropathy in hand and feet that is permanent; severe headaches with physical activity; neck weakness with range of motion deficits; persistent intermittent dizziness; neck tires easily; fatigues easily; reduced stamina; chronic pain syndrome mainly to neck and back of head; changes in sexual activity; changes in sense of identity and well-being; unable to perform prior work duties; anxiety due to trauma of injury and change in level of function; cannot lift heavy weights without experiencing severe headache; panic attacks requiring medical management; cervical spine instability; GI bleeding which required hospitalization and transfusion; portion of skull permanently removed; and that he will require spinal fusion in future to stabilize neck.
The matter was settled before trial for a sum which cannot be disclosed based upon a confidentiality agreement among the parties.
