Neurosurgery Skull Base fellowship programs in the United States have steadily increased. It remains unclear whether this growth has been accompanied by a proportional rise in skull base-specific job opportunities, raising concern that graduates may not practice within their subspecialty. This cross-sectional study evaluated career outcomes of Skull Base fellowship graduates. Data were obtained from program websites, professional networking platforms, and fellowship registries. U.S. programs listed in the North American Skull Base Society (NASBS) and American Association of Neurological Surgeons directories were included. Accreditation was verified through the Committee on Advanced Subspecialty Training (CAST) directory. Data were analyzed to summarize program characteristics and fellow demographics. Multivariate logistic regression identified factors associated with academic affiliation or skull base–specific job titles. A total of 146 graduates from 34 programs over 6 years were identified. CAST accreditation was present in 51.4% of programs for skull base surgery, 64.7% for neurosurgical oncology, and 20.6% for both. Most programs participated in the NASBS Match (64.7%). Approximately 30% of graduates were employed in academic positions. NASBS Match participation was associated with lower odds of academic employment (odds ratio [OR]: 0.47, 95% confidence interval [CI]: 0.25–0.90). Increasing program age was associated with lower odds of skull base employment (OR: 0.97, 95% CI: 0.94–0.99), but was not significantly associated with academic employment (OR: 0.97, 95% CI: 0.94–1.01). An increasing trend toward multiple fellowships was observed. Approximately 30% of graduates hold academic positions, with increasing trends toward multiple fellowships and institutional retention after training.
Objective: To characterize surgical outcomes of juvenile nasopharyngeal angiofibroma (JNA) resections performed at Mayo Clinic over a 15-year period, with particular focus on the relationship between tumor stage, surgical approach, and outcomes. Methods: Retrospective review of all patients with JNA who underwent resection at Mayo Clinic between January 2010 and January 2025. Demographics, presenting symptoms, University of Pittsburgh Medical Center (UPMC) stage, tumor volume, operative details, and outcomes were collected. Associations between tumor characteristics, surgical approach, and outcomes were analyzed. Results: Forty-four male patients (mean age, 18.0 ± 5.1 years) were included; 43 (97.7%) underwent preoperative embolization. Most (81.8%) had exclusively endoscopic resections, 13.6% combined endoscopic–open, and 4.5% open. Residual disease occurred in 6.8% and recurrence in 6.8% of patients during follow-up. Patients with advanced UPMC stage (IV–V) were significantly more likely to require open/combined approaches (41.2% vs 3.8%, p=0.004), had longer operative times (482.0 vs 317.6 minutes, p=0.001), and higher blood loss (365.0 vs 100.0 mL, p=0.006). In contrast, tumor volume was not significantly associated with surgical outcomes. Recurrence rates did not differ significantly by stage or by presentation with primary versus recurrent disease. Conclusion: In the modern era, most JNAs can be managed endoscopically with favorable outcomes. Advanced-stage tumors often necessitate combined or open approaches, with greater intraoperative morbidity but comparable outcomes. The UPMC staging system correlates more reliably with operative outcomes than tumor volume, underscoring its value for preoperative planning.
Objectives Globe-sparing surgery for orbit-involving sinonasal neoplasms (OISNs) is increasingly an option since the introduction of effective neoadjuvant treatments. Even if vision is preserved, loss of orbital support structures can cause major ocular sequelae. This study analyzed long-term ophthalmic outcomes following globe-sparing maxillectomy (GSM). Design, Settings, Participants We retrospectively reviewed all cases of GSM for OISNs with at least 1 year of ophthalmology follow-up at a tertiary care multisite institution from 2005 to 2024. Main Outcome Measures Patient demographics, surgical details, ophthalmic findings, and final oncologic status were recorded. Orbital involvement was graded based on preoperative computed tomography imaging, and outcomes were compared across orbital involvement grades. Results Thirty-three patients (39% female) were included, with a mean age of 56 +/- 18 years and a median follow-up of 2 years (range 1-12 years). Eleven patients (33%) had Grade I, 19 (58%) had Grade II, and 3 (9%) had Grade III involvement. With higher grades of orbital involvement, patients had a higher likelihood of receiving a preoperative ophthalmic exam (p < 0.001) and experiencing preoperative globe malposition (p = 0.015). Patients with higher-grade orbital involvement had a greater frequency of most ophthalmic symptoms postoperatively. Final best visual acuity was 20/40 or better in 82% of Grade I patients and 71% of Grade II/III patients (p = 0.681). Conclusion GSM for OISNs offers a favorable visual prognosis. Ocular structural and functional impairment were observed at high frequency after surgery, even with lower-grade orbital involvement. Establishing ophthalmic care for all OISN patients is critical to adequately manage ocular sequelae.
Objective To quantify lateral extension over the optic canal (OC) through endoscopic endonasal approaches (EEAs) and present techniques to maximize lateral extension. Methods On 20 sides of 10 specimens, transplanum EEAs were performed. The OC roof was drilled maximally laterally. The lateral anterior cranial fossa (ACF) dura accessed was marked; its distance from lateral OC was measured at the proximal and distal OC. To enhance lateral drilling, we performed a posteromedial orbital decompression (POD)-removal of the posteromedial lamina papyracea and orbital apex bone-and continued lateral drilling. New lateral limits were marked and measured. Results At proximal OC, the transplanum approach accessed the full width of ACF dura overlying OC in 55% of sides; POD addition provided access in 100% of sides ( p < 0.01). At proximal OC, the transplanum approach provided access to ACF dura an average of 0.7 mm lateral to OC; POD addition provided an average access of 6.0 mm lateral to OC ( p < 0.01). At distal OC, the transplanum approach accessed the full width of ACF dura overlying OC in 30% of sides dissected; POD addition afforded access in 100% of sides ( p < 0.01). At distal OC, the transplanum approach provided access to ACF dura an average of 1.1 mm medial to OC; adjunct POD provided an average access of 6.4 mm lateral to OC ( p < 0.01). Conclusion A transplanum approach affords inconsistent access to the full width of ACF dura overlying OC; adjunct POD consistently affords access to ACF dura lateral to OC and significantly increases lateral reach.
Objective Variability in the quality of operative videos presents a challenge. Several surgical subspecialties have developed scoring systems to address this issue and measure the quality of operative videos in their respective disciplines. The purpose of this project was to evaluate the quality of skull base operative videos in the neurosurgical literature and introduce a novel, neurosurgery-specific grading system-the Neurosurgery-Video Quality Scale (N-VQS)-that better discriminates educational value. Methods A cross-sectional analysis of 394 skull base operative videos published across four neurosurgical journals was performed. Videos were scored using established instruments (LAP-VEGaS, modified DISCERN, GQS, JAMA benchmark criteria) and the newly developed 14-item, 28-point N-VQS. Results A total of 394 results were included for analysis. Most videos demonstrated high baseline quality across existing grading systems, but these tools showed limited discriminatory power. The N-VQS demonstrated significant correlation with citation frequency ( p = 0.049), unlike other scales. Operative Neurosurgery had the highest mean N-VQS scores, while World Neurosurgery publications accrued the highest citation counts. Conclusion Skull base operative videos are generally high quality, but meaningful variability exists in educational components-particularly discussion of complications and supporting literature. The N-VQS offers a neurosurgery-specific, integrative framework that better correlates with academic impact and may improve standardization of operative video assessment.
