Advancing skull base surgery training in Sub-Saharan Africa: lessons from the IRCAD Africa 360° Skull Base Course

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BACKGROUND: In many low- and middle-income countries (LMCIs), particularly in Sub-Saharan Africa (SSA), skull base surgery is limited by inadequate infrastructure, scarce surgical tools, and few structured training opportunities. Given its technical complexity, requiring mastery of intricate neurovascular and craniofacial anatomy, as well as a coordinated multidisciplinary approach, these gaps pose major barriers to safe and effective care. To sustain the training of LMICs neurosurgeons, the authors propose a practical framework for establishing skull base skills laboratories in resource-limited settings. METHODS: We describe the microsurgical laboratory at IRCAD Africa, Kigali, inaugurated in October 2023, providing training for African surgeons in minimally invasive surgery (MIS) across multiple surgical disciplines; this includes skull base surgery through both open microsurgical and endoscopic techniques. Training included theoretical and practical modules, live demonstrations, and supervised cadaveric dissections. Trainees reflected daily on their learning via structured questionnaires. RESULTS: The IRCAD Africa 360° Skull Base Course, launched in May 2024 and repeated in May 2025, trained 75 surgeons from 12 African countries. The course featured 11 wet lab stations with preserved human specimens, covering six modules: antero-lateral corridor, temporal fossa floor, petrous bone and posterior petrosal approach, cranio-cervical junction, endoscopic endonasal, and extended endonasal approaches. Essential tools and practical guidelines were provided. Participants reported high satisfaction with both theory and hands-on training. CONCLUSION: SSA neurosurgeons show growing interest in developing skull base surgery skills. Cadaveric dissection remains the most effective training method and the IRCAD Africa 360° Skull Base Course demonstrates that high-level skull base education can be successfully delivered in resource-limited settings.

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