2026 Proffered Presentations
S170: FROM FELLOWSHIP TO REALITY: DEVELOPMENT OF A SKULL BASE SURGERY UNIT IN A PUBLIC HEALTH SYSTEM FROM INCEPTION
Miguel Saez-Alegre, MD, PhD1; Adriana Lodeiro Colatosti, MD2; Maria Dolores Costa Climent, MD2; Mayra Alejandra Botero Vargas, MD2; Pablo Abellan Galiana, MD, PhD3; Marc Aparisi Pons, MD4; Marta Faubell Serra, MD2; Oscar Cortes Andres, MD1; 1Department of Neurosurgery. General University Hospital of Castellón (Spain); 2Department of Otorhinolaryngology. General University Hospital of Castellón (Spain); 3Department of Endocrinology. General University Hospital of Castellón (Spain); 4Department of Radiology. General University Hospital of Castellón (Spain)
Introduction: Skull base surgery requires a structured, multidisciplinary approach, typically concentrated in high-resource, tertiary centers. Despite the growing number of fellowship-trained specialists, dedicated positions in skull base surgery remain limited. Paradoxically, many regions within developed healthcare systems still lack adequate access to specialized care. This report describes the creation of a skull base unit in a public hospital in Spain without prior structured skull base activity, led by a specialist trained through a CAST-accredited fellowship in the United States.
Methods: A multidisciplinary team was formed, including neurosurgery, otorhinolaryngology, ophthalmology, radiology, and endocrinology. The hospital had prior experience in microscopic endonasal surgery but no endoscopic skull base program. A thorough review of existing capabilities was conducted, adapting available resources; only one additional device—a dedicated endonasal bipolar forceps—was acquired. A monthly multidisciplinary board was established to evaluate both anterior and lateral skull base cases.
Results: The hospital serves a population of approximately 650,000 inhabitants, with seasonal increases due to tourism and a large retired population. In the first six months, 18 cases of skull base pathology were treated surgically. More than 30 additional cases were discussed in the monthly committee. All procedures were performed in standard operating rooms using existing infrastructure.
Discussion: This initiative demonstrates that, even in the absence of additional funding, it is possible to develop a skull base unit within a public system by optimizing existing resources and fostering structured interdisciplinary collaboration. The limited number of formal positions in skull base surgery contrasts with the unmet needs in underserved areas. Identifying such gaps allows highly trained specialists to create opportunities and improve access to care, even in resource-constrained environments.
Conclusion: A skull base unit can be successfully implemented in a public healthcare setting without major financial investment. With expert leadership, interdepartmental cooperation, and strategic resource utilization, it is possible to extend complex surgical care to regions previously lacking access.