title: Acquisition of surgical skills for endonasal skull base surgery: a training program.
abstract: BACKGROUND
  Endonasal surgery represents a radical change in the practice of cranial base surgery and requires the acquisition of new knowledge and surgical skills. The optimal training program for surgeons has not been established.
  
  
  METHODS
  We reviewed our experience with endonasal cranial base surgery from 1998 to 2006 to develop a training plan for the acquisition of surgical skills. It consists of a modular and incremental approach to endonasal skull base surgery that is designed to train surgeons to function as a team, learn endoscopic skull base anatomy, and develop fundamental endoscopic skills.
  
  
  RESULTS
  Stages of training are established for the otolaryngologist-head and neck surgeon and the neurosurgeon that are based on level of technical difficulty, potential risk of vascular and neural injury, and unfamiliar endoscopic anatomy. Mastery of each level is recommended before attempting procedures at a higher level.
  
  
  CONCLUSIONS
  Standardization of training and the adoption of a modular, incremental training program are expected to facilitate the training of endonasal surgeons in both surgical specialties. Adherence to such a program during the growth phase of endoscopic skull base surgery may decrease the risk of complications as the surgeon's knowledge and surgical expertise develop.
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA. snydermanch@upmc.edu
authors.forename: Carl
authors.initials: C
authors.lastname: Snyderman
authors.forename: Amin
authors.initials: A
authors.lastname: Kassam
authors.forename: Ricardo
authors.initials: R
authors.lastname: Carrau
authors.forename: Arlan
authors.initials: A
authors.lastname: Mintz
authors.forename: Paul
authors.initials: P
authors.lastname: Gardner
authors.forename: Daniel M
authors.initials: DM
authors.lastname: Prevedello
mesh_terms: D001165:Arteriovenous Malformations / Q000000981:diagnostic imaging / Q000601:surgery; D001933:Brain Stem / Q000473:pathology / Q000601:surgery; D002533:Cerebral Angiography; D002983:Clinical Competence; D019299:Decompression, Surgical / Q000379:methods; D004493:Education / Q000592:standards*; D004724:Endoscopy / Q000379:methods; D006801:Humans; D007858:Learning; D020221:Optic Nerve Injuries / Q000209:etiology / Q000601:surgery; D009917:Orbital Fractures / Q000150:complications / Q000601:surgery; D013517:Otorhinolaryngologic Surgical Procedures / Q000193:education* / Q000379:methods*; D010256:Paranasal Sinuses / Q000000981:diagnostic imaging / Q000601:surgery*; D010911:Pituitary Neoplasms / Q000473:pathology / Q000601:surgery; D019291:Skull Base; D013100:Sphenoid Bone / Q000098:blood supply / Q000601:surgery; D013117:Spinal Cord Compression / Q000473:pathology / Q000601:surgery; D014057:Tomography, X-Ray Computed