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

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.

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.

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.

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.