Career Trajectories for Neurosurgical Skull Base Fellows: 2019 to 2025

Abstract 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.