Abstract
Risk management is supposed to be the first priority issue in many clinical fields including neurosurgery at present. The quality control of medical practice is particularly indispensable in high risk field such as neurosurgery. However, as it is apprehensive that the open and straightforward discussion on the concrete events and all incidences may invoke unnecessary controversies, the practical concrete risk management in each field is not always well investigated. The most controversial point is the definition of incidence, malpractice and complications. These three categories are discriminated by complicated factors such as its severity, frequency and artificial error. It is quite important to have an open discussion on the every event from this point of view by all members in its facilities. In clinical neurosurgery, most of incidences occur in the ward. Among them, drainage trouble and fall down trouble are most frequently seen in neurosurgical ward. However, the most serious incidences occur in operating room. Residual foreign body such as cotton paddy is most frequently encountered. The thoroughgoing practice of manual to prevent this incidence is quite effective. In examination room, angiography has high risk. Some complications such as cholestelin embolus are still inevitable. The most practical risk management is to avoid unnecessary procedures. In out-patient clinic, the misdiagnosis such as the minor ischemic event is critical. This incidence is often caused by the system of its facility. As conclusion, for the more effective and practical risk management, we neurosurgeons have to organize the systematic nationwide data accumulation.
