gms | German Medical Science

Objective: Skull base surgery requires 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: Approx. 150 retrosigmoid approaches for various skull base pathologies are being performed at the Department of Neurosurgery annually. Residents perform their first skull base approaches after a minimal assisting term of 6 months, followed by participation in dissection courses (EANS, DGNC) and continuous anatomical training, later performing their first approaches under direct supervision of a master surgeon. With this study we evaluate the surgical morbidity related to the educational level of the surgeon.

Results: Comparing surgery related morbidity between approaches performed by an experienced surgeon (> 100 procedures) and young residents (< 20 procedures) we found no significant differences 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.

Conclusions: Respecting 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.