Skull Base Surgery Training and Practice Patterns among Recent Otolaryngology Fellowship Graduates

Background: Skull base surgical techniques, including advanced endoscopic approaches, are now being incorporated into an increasing number of otolaryngology training programs. The purpose of this survey is to collect data on skull base surgery training experiences and current skull base practice patterns of young otolaryngologists.

Methods: A 24-item survey was disseminated electronically to physicians from across the United States who completed otolaryngology fellowship programs in rhinology, head and neck oncology, or neurotology within the past 5 years. Demographic, training, and practice pattern information was obtained.

Results: The survey response rate was 29.6% (29/98). The mean age of respondents was 36 years with 76% men and 24% women currently in practice for 1.7 years on average. Overall, 35% of respondents completed a rhinology fellowship, 17% completed a head and neck oncology fellowship, and 48% completed a neurotology fellowship. Academic practice settings (79%) were more common than private practice (21%), and 59% of respondents were directly affiliated with a skull base surgery program. In total, the percentage of surgical practice dedicated to skull base surgery was < 20% in 72% of respondents, 21 to 50% in 24%, and > 50% in 3%. During fellowship, > 20 anterior skull base cases were performed in 90% of rhinology-trained respondents, > 20 cases were performed in 20% of head and neck respondents, and > 50 lateral skull base cases in 93% of neurotology-trained physicians. During a typical year in practice, 50% of rhinology-trained otolaryngologists performed >20 endoscopic skull base cases, 90% performed <20 open skull base cases, and generally reported feeling more confident performing a range of endoscopic approaches rather than open procedures. Head and neck-trained otolaryngologists performed < 20 endoscopic and < 20 open cases during a typical year in 100% of respondents, and reported feeling more confident with open rather than endoscopic approaches. Neurotology-trained otolaryngologists performed < 20 lateral skull base cases in 57% of respondents, 21–50 cases in 36%, and reported feeling very comfortable performing a variety of lateral skull base approaches.

Conclusion: Many recent graduates from otolaryngology fellowship programs are integrating skull base surgery, particularly advanced endoscopic techniques, into their practices at an early stage. Overall, respondents reported high confidence levels when independently performing a range of approaches to the cranial base. Rhinology fellowship training appears to offer increased exposure to anterior skull base surgery as compared with head and neck training.