Endoscopic Skull Base and Advanced Rhinology Training in Neurorhinology Fellowships: Standardization and Case Classification of Operative Volume

Background: Continued advancement in the field of endoscopic skull base (ESB) surgery has allowed for progressive use of endoscopic techniques in the management of complex skull base pathology. Fellowship-training programs have had to adapt their training paradigm to account for the evolution in surgical management. For this reason, the Rhinology Training Council (RTC) was created as an oversight committee for the goal of establishing uniform training. However, there remains limited transparency regarding the specific endoscopic and open skull base volume that exists within the neurorhinology training fellowships. Despite this evolution in ESB surgery, fellowship level skull base training remains fairly nonstandardized, and the diversity of operative cases within each fellowship has not been well studied.

Objective: The goal of this study is to survey published information across the North American Skull Base Society (NASBS) and American Rhinologic Society (ARS) Web sites with regard to skull base training paradigm and characteristics of the operative volume. We sought to assess how fellowship programs delineate their training experience with respect to unique operative volume. This study will provide a better understanding of how fellowship training has potentially changed to accommodate evolving surgical treatments, and where opportunities for improved transparency can be achieved.

Methods: Online information in the NASBS and ARS Web sites was studied with a specific focus on open versus endoscopic skull base, advanced rhinologic, and standard sinonasal surgery volume for each program. Emphasis was placed on understanding what proportion of rhinology fellowships incorporated skull base and advanced rhinology training and how these cases were classified. Additionally, the RTC’s guidelines for neurorhinology accreditation were assessed in the scope of published case numbers for each program.

Results: Of 32 published rhinology fellowships in the ARS database, 28 (88%) fellowships report anterior and middle skull base training over a yearlong training program. Of these 28, 11 (39%) programs have published case numbers to demonstrate the level of skull base experience to be expected during the training period. Overall, the experience in anterior and middle skull base surgery range from 20 to 65% of the overall operative volume. With respect to the RTC’s guidelines including skull base approaches, resection of sinonasal tumors, skull base reconstruction, and advanced rhinologic procedures, there is minimal transparency in operative volume with respect to these categories. There are no uniform descriptive parameters for characterizing the nature of skull base and advanced rhinologic experience in a single fellowship to allow for comparative evaluation

Conclusion: With evolving surgical corridors and widespread advancements in endoscopic technology, rhinologists have become a vital component of the skull base surgery team. However, the advanced rhinology-training paradigm remains poorly characterized. The establishment of the RTC within the ARS has been a pivotal first step in better establishing standardization. However, improved knowledge of how operative cases are classified per institution will help understand the diversity in surgical experience. Improvements in classification of fellowship training and case characteristics will not only allow potential fellows to better understand what unique experiences each fellowship offers but also globally improve fellowship education in advanced rhinologic surgery.