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W e describe, in this Perspective, the shocking effect of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) outbreak on the Department of Neurosurgery of Papa Giovanni XXIII Hospital in Bergamo, which represents at the moment the most affected city in the entire Italian territory (Figure 1). 1 This epidemic is challenging the Italian Government and the health care system and is having a devastating impact on all the health activities, including the neurosurgical reality.

The Weeping Woman series is regarded as a thematic continuation of the tragedy depicted in Picasso's epic painting Guernica. In focusing on the image of a woman crying, the artist was no longer painting the effects of the Spanish Civil War directly, but rather referring to a singular universal image of suffering. More information: https://www.pablopicasso.org/the-weeping-woman.jsp

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BACKGROUND:Several microsurgical transcranial approaches (MTAs) and endoscopic transnasal approaches (EEAs) to the anterior cranial fossa (ACF) have been described.OBJECTIVE:To provide a preclinical, quantitative, anatomic, comparative analysis of surgical approaches to the ACF.METHODS:Five alcohol-fixed specimens underwent high-resolution computed tomography. The following approaches were performed on each specimen: EEAs (transcribriform, transtuberculum, and transplanum), anterior MTAs (transfrontal sinus interhemispheric, frontobasal interhemispheric, and subfrontal with unilateral and bilateral frontal craniotomy), and anterolateral MTAs (supraorbital, minipterional, pterional, and frontotemporal orbitozygomatic approach). An optic neuronavigation system and dedicated software (ApproachViewer, part of GTx-Eyes II—UHN) were used to quantify the working volume of each approach and extrapolate the exposure of different ACF regions. Mixed linear models with random intercepts were used for statistical analyses.RESULTS:EEAs offer a large and direct route to the midline region of ACF, whose most anterior structures (ie, crista galli, cribriform plate, and ethmoidal roof) are also well exposed by anterior MTAs, whereas deeper ones (ie, planum sphenoidale and tuberculum sellae) are also well exposed by anterolateral MTAs. The orbital roof region is exposed by both anterolateral and lateral MTAs. The posterolateral region (ie, sphenoid wing and optic canal) is well exposed by anterolateral MTAs.CONCLUSION:Anterior and anterolateral MTAs play a pivotal role in the exposure of most anterior and posterolateral ACF regions, respectively, whereas midline regions are well exposed by EEAs. Furthermore, certain anterolateral approaches may be most useful when involvement of the optic canal and nerves involvement are suspected.

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