OBJECTIVES With the aim of identifying the factors related to sentences against neurosurgeons, we have analyzed all the sentences issued in the second court of justice in Spain against neurosurgeons in the period from 1995 to 2007. MATERIAL AND METHODS Of a total of 1899 sentences of the second or last appeal, during the period from 1995 to 2007 issued in Spain, 61 were chosen which fulfill the criteria to be included in our study. 25 variables were included on the record of compiled data. A complete descriptive and comparative study was elaborated, as well as an analysis of the type of suits, circumstances, and professionals involved. RESULTS In a third of the cases, complete malpraxis was identified. In regards to the sentences, they were absolved in approximately half the cases, resolved with one fifth of the cases being penal, and four fifths with compensation. Indemnity quantities range from 60,000 to 600,000euro. Deficiency of information or consent was noted in 17% of lawsuits. 62.5% of operations in our sample were on the anatomic region of the vertebral column followed in frequency by the cranial region with 28.6%. Consequences of surgical procedure included major permanent sequelae in 40% of the cases and death in 22%. CONCLUSIONS It is wise to invest time to deal with patients, including the verbal informed consent, which must be confirmed by the written informed consent form. It is also important to leave a written proof of medical praxis, both related to surgical records and to diagnosis and follow-up of the patient. Procedures with a lower life-threatening risk should not be underestimated, since they comprise the greatest demanded group. The greatest amount of demands is related to economic reimbursement, especially in private practice.