Skull base surgery is a highly innovative, multidisciplinary field that today demands
collaboration between teams of neurosurgeons, otolaryngology—head and neck surgeons
(OHNS), plastic surgeons, ophthalmologists, radiation oncologists and others. However,
not long ago, this nascent field was instead characterized by isolated individual
brilliance. Here, we explore the contributions of several key players towards breaking
dogmatic silos, overcoming rigid barriers and transforming the field into one that
encourages and fosters collaboration. Our analysis centers on the formation of the
North American Skull Base Society (NASBS), and the instrumental role it played in
the development of skull base surgery. We analyzed documents from initial NASBS meetings
and interviewed 12 past-presidents of the NASBS and two prominent figures in skull
base surgery ([Fig. 1]).
Several key players propelled the growth of skull base surgery in the late 20th century.
Interestingly, each of these individuals sought out education from not only mentors
within their field, but also across specialties. Gradually, interdisciplinary intraoperative
collaboration emerged on a national level as the most effective means of approaching
the skull base region. Paul Donald, 1st NASBS President, described the new mentality
that “if you do it together, you get the best of each specialty.” In March 1987, “a
group of about 18–20 neurosurgeons and otolaryngologists got together and met at a
working group meeting,” as Jatin Shah, 15th NASBS President, recalls. Donald described
that meeting in the first edition of the Petrous Pulse, the official newsletter of
the NASBS, noting that “the discussions lead to the decision to form a Skull Base
Study Group” ([Fig. 2]).
The NASBS was founded in 1989 with the mission of facilitating worldwide communication
and collaboration between individuals pursuing clinical and research excellence in
skull base surgery. The group held its first organizational meeting in February 1989,
and its first NASBS Annual Meeting in February 1990 with Paul Donald serving as the
inaugural president ([Figs. 2] and [3]). Donald formally invited select physicians to attend the meeting as founding members
of this, “exciting new organization that is eclectic in its scope, encompassing a
number of diverse specialties all striving for a common goal that is at the frontier
and cutting edge of medicine” ([Fig. 3]).
The NASBS has grown enormously in the 35 years since its establishment. According
to Shah, it expanded from 40 attendees at its first organizational meeting to approximately
250 founding members ([Fig. 4A]). Now, the NASBS has 1,157 members with over 1,000 attendees at its most recent
33rd Annual Meeting in Atlanta, GA ([Fig. 4C]). Formal fellowship training has also played a fundamental role in disseminating
knowledge and technical expertise to allow the field to grow. In 1992, there were
only seven skull base fellowships available nationally ([Fig. 4D]). Today, there are 60 multidisciplinary skull base fellowships available. Furthermore,
the NASBS remains highly multidisciplinary in its membership ([Fig. 4B, C]). Collaboration and innovation have been fundamental to skull base surgery since
the subspecialty’s inception and will continue to elevate the field in years to come.
