Skull Baseline: A Cross-sectional Analysis of Anatomical Curricula in U.S. Neurosurgery Training Programs

Abstract

Introduction

Assessments of contemporary skull base education as a component of neurosurgery residency programs in the United States are lacking. We sought to conduct and report a novel analysis focusing on access to key educational resources and professional development opportunities.

Methods

Cross-sectional survey-based descriptive analysis of skull base education resources across all neurosurgery residency training programs and skull base fellowships in the United States. Program directors of 117 U.S. neurosurgery residency programs were solicited using a standardized questionnaire; 93 (80%) responded.

Results

Among responding programs, 19% (18/93) reported having all four key resources: cadaveric dissection laboratories, dedicated skull base rotations, enfolded or postgraduate fellowship program, and fellowship-trained skull base faculty. Cadaveric dissection laboratories were present in 97% of programs with skull base fellowships and 93% without fellowships (p > 0.05). Programs with fellowships had significantly more fellowship-trained faculty (mean 2.5 vs. 1.7, p = 0.004). Of the 34 identified skull base fellowships, 47% were Committee on Advanced Subspecialty Training (CAST)-accredited, and most offered one fellow position annually. The mean annual fellowship caseload was 273 (standard deviation = 104), with no significant difference between CAST-accredited and nonaccredited fellowships (p = 0.8). Nearly half of fellowships with a reported founding year were established within the past decade.

Conclusion

Skull base education resources are highly variable across neurosurgery residency training programs, apart from the near-universal access to cadaveric dissection laboratories. Further studies are needed to optimize skull base education and professional development opportunities for trainees.

Keywords

skull base surgery - residency training - fellowship - neurosurgery - cadaveric laboratory - neurosurgical education

^* Equal contribution

Publication History

Received: 24 March 2025

Accepted: 03 June 2025

Accepted Manuscript online:
05 June 2025

Article published online:
17 June 2025

• References

• 1 Prestigiacomo CJ, Dagi TF. The history of skull base surgery. Neurosurg Focus 2012; 33 (02)
• 2 Pojskić M, Čustović O, Erwin KH. et al. Microscopic and endoscopic skull base approaches hands-on cadaver course at 30: historical vignette. World Neurosurg 2020; 142: 434-440
• 3 Ormond DR, Hadjipanayis CG. The history of neurosurgery and its relation to the development and refinement of the frontotemporal craniotomy. Neurosurg Focus 2014; 36 (04) E12
• 4 About Us. NASBS. Accessed March 12, 2025 at https://www.nasbs.org/about
• 5 Plute T, Bin-Alamer O, Mallela AN. et al. A comprehensive analysis of academic attributes of the presidents of the North American Skull Base Society. J Neurol Surg B Skull Base 2023; 85 (06) 555-562
• 6 Welcome to the ESBS. European Skull Base Society. Accessed at: https://www.esbs.eu/about-us/
• 7 History of BSBS. British Skull Base Society. Accessed at: https://skullbase.co.uk/pages/history-of-bsbs
• 8 Ivan ME, Jahangiri A, El-Sayed IH, Aghi MK. Minimally invasive approaches to the anterior skull base. Neurosurg Clin N Am 2013; 24 (01) 19-37
• 9 Maroon JC. Skull base surgery: past, present, and future trends. Neurosurg Focus 2005; 19 (01) E1
• 10 Skull Base Fellowship Registry. NASBS. Accessed at: https://www.nasbs.org/fellowship-registry/
• 11 Graffeo CS, Link MJ, Lawton MT. Complex cranial surgery and the future of open cerebrovascular training. J Neurosurg 2022; 137 (05) 1554-1561
• 12 Sharma R, Katiyar V, Narwal P, Kale SS, Suri A. Interval assessment using task- and procedure-based simulations: an attempt to supplement neurosurgical residency curriculum. Neurosurg Focus 2022; 53 (02) E2
• 13 Isolan GR, Monteiro J, Vaz MAS. et al. The learning curve in skull base surgery part 1–from historical-philosophical concepts to microsurgical lab training. Arq Bras Neurocir 2022; 41 (04) e340-e347
• 14 Singh R, De La Peña NM, Suarez-Meade P. et al. A mentorship model for neurosurgical training: the Mayo Clinic experience. Neurosurg Focus 2022; 53 (02) E11
• 15 Di Maio S, Ramanathan D, Garcia-Lopez R. et al. Evolution and future of skull base surgery: the paradigm of skull base meningiomas. World Neurosurg 2012; 78 (3–4): 260-275
• 16 Yaeger KA, Munich SA, Byrne RW, Germano IM. Trends in United States neurosurgery residency education and training over the last decade (2009-2019). Neurosurg Focus 2020; 48 (03) E6
• 17 Santyr B, Abbass M, Chalil A. et al. High-fidelity, simulation-based microsurgical training for neurosurgical residents. Neurosurg Focus 2022; 53 (02) E3
• 18 Patel NS, Gompel JJV, Tombers NM, Link MJ, Carlson ML. A cross-sectional survey of the North American Skull Base Society part 3: the state of lateral skull base surgery training in North America. J Neurol Surg B Skull Base 2019; 80 (04) 399-415
• 19 Schwartz TH, Morgenstern PF, Anand VK. Lessons learned in the evolution of endoscopic skull base surgery. J Neurosurg 2019; 130 (02) 337-346
• 20 Hoffman SE, Vega RA, Stippler M. Teaching through the screen: a toolbox for creating a virtual neurosurgical subinternship program. Neurosurg Focus 2022; 53 (02) E7
• 21 Kirsch EP, Suarez A, McDaniel KE. et al. Construct validity of the surgical autonomy program for the training of neurosurgical residents. Neurosurg Focus 2022; 53 (02) E8
• 22 Nguyen S, Cole KL, Timme KH, Jensen RL. Development of a residents-as-teachers curriculum for neurosurgical training programs. Neurosurg Focus 2022; 53 (02) E6
• 23 Clarke MJ, Frimannsdottir K. Assessment of neurosurgical resident milestone evaluation reporting and feedback processes. Neurosurg Focus 2022; 53 (02) E5
• 24 Bruening DM, Truckenmueller P, Stein C. et al. 360° 3D virtual reality operative video for the training of residents in neurosurgery. Neurosurg Focus 2022; 53 (02) E4
• 25 Hickmann AK, Ferrari A, Bozinov O, Stienen MN, Ostendorp C. Neurosurgery resident training using blended learning concepts: course development and participant evaluation. Neurosurg Focus 2022; 53 (02) E13
• 26 Pahwa B, Chaurasia B, Garg K, Bozkurt I, Deora H. Factors affecting the choice of neurosurgery subspecialty: a geographic and gender-wise analysis. World Neurosurg 2023; 171: e864-e873
• 27 Mishra R, Narayanan MDK, Umana GE, Montemurro N, Chaurasia B, Deora H. Virtual reality in neurosurgery: beyond neurosurgical planning. Int J Environ Res Public Health 2022; 19 (03) 1719
• 28 Jarmula J, de Andrade EJ, Kshettry VR, Recinos PF. The current state of visualization techniques in endoscopic skull base surgery. Brain Sci 2022; 12 (10) 1337
• 29 Sung H, Ton E, Brown NJ. et al. Assessing the quality of recruitment information on skull base surgical fellowship program websites. J Neurol Surg B Skull Base 2023; 85 (Suppl. 02) e16-e27
• 30 Deora H, Yagnick NS, Tripathi M. Mentor-mentee relationship in neurosurgery: standing on the shoulder of giants. World Neurosurg 2020; 141: 110-112
• 31 Al-Ageely TA, Ismail M, Al-Araji ZA. et al. Effectiveness of mentorships and early exposure in neurosurgery. World Neurosurg 2023; 178: e773-e776
• 32 Lee TT, Klose JL. Congress of Neurological Surgeons Education Committee. Survey on neurosurgery subspecialty fellowship training. Surg Neurol 1999; 52 (06) 641-644 , discussion 644–645
• 33 Li AY, Kalagara R, Asfaw Z. et al. Subspecialty and training preferences for U.S. neurosurgery faculty with international training. World Neurosurg 2022; 164: e326-e334
• 34 Jensen R, O'Rourke D, Warnick R, Sawaya R. Resident training in neurosurgical oncology: results of the survey of North American training programs by the AANS/CNS Section on Tumors. J Neurooncol 2006; 77 (03) 241-246