2018: Current Status of Comprehensive Endoscopic Skull Base Training in Otolaryngology Fellowships

Background: Advancements in the field of endoscopic skull base (ESB) surgery has resulted in endoscopic techniques being utilized for increasingly complex anterior and middle skull base pathology. Fellowship-training programs have had to adapt their training regimen to incorporate this evolution. ESB surgery training initially evolved within the field of Rhinology and its fellowships, but in few cases has progressed to stand alone formal training programs. The range of subspecialties that encompass comprehensive skull base surgery is broad. Therefore, no single training fellowship in a subspecialty has taken full ownership of skull base training. Despite this evolution in ESB surgery, fellowship level skull base training and the proportion of operative cases within each fellowship have not been well studied.

Objective: The objective of this study is to evaluate published information across the American Rhinologic Society (ARS) and North American Skull Base Society (NASBS) Web sites with regard to anterior and middle skull base surgery and ESB surgery training. This evaluation will provide a better understanding of how fellowship training has potentially changed to accommodate the evolving surgical treatment of skull base pathology.

Methods: Online information in the NASBS and ARS Web sites were reviewed with a specific focus on anterior and middle skull base surgery training and ESB surgery training. Emphasis was placed on understanding what proportion of Otolaryngology fellowships incorporated anterior and middle skull base training. Of these programs we sought to understand how anterior and middle skull base training was divided among Rhinology, Head and Neck Oncology, or dedicated Skull Base Surgery fellowships based on descriptive characteristics on the noted Web sites.

Results: Of the 32 published rhinology fellowships in the ARS database, 28 (88%) fellowships report anterior and middle skull base training over a year-long training program. Of these 28 programs, only 11 (39%) programs have available case numbers to demonstrate the level of skull base experience to be expected during the training period. Distinct from the ARS database, there are nine skull base surgery fellowships identified on the NASBS Web site that self-identify as head and neck oncology fellowships with a skull base focus, advanced rhinology/skull base fellowships, or comprehensive skull base fellowships. Of all the published fellowships, the experience in anterior and middle skull base surgery range from 20 to 65% of the overall operative volume. Lastly, 22 (54%) of the skull base training programs incorporate training in open skull base approaches. There are no standardized descriptive parameters for characterizing the nature of skull base experience in a single fellowship to allow for comparative evaluation.

Conclusion: With revolutionary technology and evolving surgical techniques, Otolaryngologists have become a vital component of the skull base surgery team. However, the otolaryngology training paradigm remains poorly characterized. As the fellowship model continues to transform with dedicated skull base surgery fellowships, better classification of fellowship training and key indicator case characteristics will allow trainees to better understand what unique experiences each fellowship offers. This should be the first step in improving fellowship training quality for skull base surgery.