Respecting a Step-by-Step Education in Skull Base Surgery Leads to Low Approach-Related Morbidity Rates for Young Residents

Introduction: Skull base surgery requires a profound knowledge of anatomy and surgical skills. The skull base approach is the crucial step for successful intradural performance. Resident training at experienced institutions must consider this background when educating young neurosurgeons.

Methods: Our Department of Neurosurgery performs approximately 150 surgeries using the retrosigmoid approaches for various skull base pathologies annually. Residents perform their first skull base approaches after assisting for these surgeries a minimum of 6 months, followed by participating in dissection courses (EANS, DGNC) and continuous anatomical training. They perform their first approaches under direct supervision of a master surgeon. With this study, we evaluate the surgical morbidity rate in relation to the educational level of the surgeon.

Results: Comparing surgically related morbidity between approaches performed by an experienced surgeon (>100 procedures) and those performed by young residents (<20 procedures), we found no significant differences (P < 0.01) concerning CSF fistula, wound infections, occipital nerve neuromas, or bone flap displacements. However, the mean time for the procedure (positioning, time-to-dural incision) was significantly longer in the trainee group.

Conclusion: Respecting the step-wise educational levels for skull base surgery, including microanatomical studies, educational courses, and expert guidance at surgery, skull base approaches can be performed by young residents without increased morbidity at experienced institutions.