Postmortem brain dissection (Autopsy)

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[starttext]A. Opening the Skull:
  1. Separate the hair and incise the scalp across the vertex from one mastoid process just behind the ear to another.
  2. Reflect the scalp forwards and backwards past the hairline. Note injury to skull or deeper tissues of scalp.
  3. Cut temporalis and masseter muscles on either side.
  4. Cut the calvarium with the saw in a slightly "V" shaped fashion. Remove the skull cap by inserting and twisting chisel at the sawline.
  5. Examine meninges and note extradural or subdural hemorrhage if any.

B. Removing the Brain:
  1. Open superior longitudinal sinus. Examine for antemortem thrombus.
  2. Cut dura along the sawline of skull and reflect towards the midline. Inspect the surface of brain.
  3. Retract the frontal poles and cut anterior attachments of falx cerebri (i.e cribiform plate).
  4. Elevate olfactory bulbs by inserting fingers between the frontal lobes and skull and drawing them backwards, retract the brain and cut: optic nerves, carotid arteries and other nerves.
  5. Retract brain medially and cut tentorial attachments along the petrous ridges.
  6. Retract brain posteriorly and cut remaining cranial nerves as close to bone as possible, vertebral arteries and spinal cord as distally as possible within the spinal canal.
  7. Retract cerebellum and brainstem. Support brain and cut remaining dural attachment with scissors. Remove the brain from the cranial vault.

C. Dissecting the brain:
  1. Brain can be fixed in 10% formalin to dissect later or it can be dissected at the moment.
  2. Remove brainstem and cerebellum by thin knife section across the the cerebral peduncle in a planes perpendicular to the brainstem and aqueduct. 
  3. Perform serial cross-section of the brainstem along the same plane and inspect for substantia nigra in medulla.
  4. Cerebellum may be sectioned in a plane parallel to the long axis of brainstem. Observe the vermis and dentate nucleus.
  5. Carefully inspect for surface vessels, cranial nerves, midline structures i.e. cingulate gyri, unci, mammilary body, pineal recess and the remaining part of brainstem.
  6. Use serial coronal section at about 1 cm interval for the dissection of cerebral hemispheres. Examine the corpus callosum, thalamus, internal capsule and basal nuclei.
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