Abstract: Starting in July 2022, three skull base-trained surgeons (C.A.M., C.A.R., A.M.T.) developed the first Multidisciplinary Skull Base Program (MSBP) at Walter Reed National Military Medical Center (WRNMMC). Our aim was to provide integrated surgical care for complex open and endoscopic approaches to the skull base for myriad pathologies. WRNMMC, like many other Military Training Facilities (MTFs), loses a significant number of complex cases to the civilian network because of civilian deferment programs and lack of awareness of institutional capabilities. We briefly review our skull base experience regarding case volume and describe the challenges and opportunities to grow the program in support of graduate medical education, the military health system (MHS), and the fighting force. Consecutive skull base case logs were retrospectively compared between 2 time periods: July 2020 to June 2022 (Period 1) and July 2022 to June 2024 (Period 2). Skull base cases included open, endoscopic, and combined (simultaneous open and endoscopic) approaches involving the anterior, middle, and posterior skull base. All cases in Period 2 involved at least 1 fellowship trained skull base surgeon (C.A.M., C.A.R., A.M.T.). We defined the start of MSBP as the beginning of Period 2 when all 3 fellowship-trained skull base surgeons first became stationed together. We reviewed the pathologies and approaches for each case.