Symmetric Bihemispheric Postmortem Brain Cutting to Study Healthy and Pathological Brain Conditions in Humans

Abstract

Neuropathologists, at times, feel intimidated by the amount of knowledge needed to generate definitive diagnoses for complex neuropsychiatric phenomena described in those patients for whom a brain autopsy has been requested. Although the advancements of biomedical sciences and neuroimaging have revolutionized the neuropsychiatric field, they have also generated the misleading idea that brain autopsies have only a confirmatory value. This false idea created a drastic reduction of autopsy rates and, consequently, a reduced possibility to perform more detailed and extensive neuropathological investigations, which are necessary to comprehend numerous normal and pathological aspects yet unknown of the human brain. The traditional inferential method of correlation between observed neuropsychiatric phenomena and corresponding localization/characterization of their possible neurohistological correlates continues to have an undeniable value. In the context of neuropsychiatric diseases, the traditional clinicopathological method is still the best possible methodology (and often the only available) to link unique neuropsychiatric features to their corresponding neuropathological substrates, since it relies specifically upon the direct physical assessment of brain tissues. The assessment of postmortem brains is based on brain cutting procedures that vary across different neuropathology centers. Brain cuttings are performed in a relatively extensive and systematic way based on the various clinical and academic contingencies present in each institution. A more anatomically inclusive and symmetric bi-hemispheric brain cutting methodology should at least be used for research purposes in human neuropathology to coherently investigate, in depth, normal and pathological conditions with the peculiarities of the human brain (i.e., hemispheric specialization and lateralization for specific functions). Such a method would provide a more comprehensive collection of neuropathologically well-characterized brains available for current and future biotechnological and neuroimaging techniques. We describe a symmetric bi-hemispheric brain cutting procedure for the investigation of hemispheric differences in human brain pathologies and for use with current as well as future biomolecular/neuroimaging techniques.

Central nervous system autopsy — a neuropathological procedure based on multidisciplinary pathoclinical cooperation

“…Some pathological changes are visible in the brain only after complete or partial fixation. In these situations, without full brain fixation, significant problems can arise in terms of a proper macroscopic assessment [1,4,17].…”

“…If the spinal cord is removed, it should be cut transversely to the long axis at intervals of 1 cm through the centre of the segment. All the slides should be arranged on an even flat surface, followed by proceeding to description, macroscopic assessment, photographic documentation, and collection of samples [1,4,15].…”

“…The neuropathological post mortem is important for doctors and other medical staff, as well as for administration as it helps with monitoring the quality of health services by verifying the adopted diagnostic and therapeutic procedures. In addition, it allows the detection of infectious, toxic, genetically determined, environmental and occupational diseases, and often indicates an aetiological factor [4]. An additional aim of the CNS dissection is the maintenance of the principles of good clinical practice and the long-term development of neuroscience [2,5,6].…”

Cerebral Organoids—Challenges to Establish a Brain Prototype

“…In previous studies of the nervous system development and function in health and human pathologies, the following models have been used: animal models in vivo [ 1 , 2 , 3 , 4 , 5 ]; intravital sections of the brain ex vivo [ 6 , 7 , 8 ]; primary neuronal culture of cells or brain tissue in vitro [ 9 , 10 , 11 , 12 , 13 ], and, to a lesser extent, post-mortem material [ 14 , 15 , 16 , 17 , 18 ]. All these experimental methodological approaches have their limitations.…”

Abbiategrasso Brain Bank Protocol for Collecting, Processing and Characterizing Aging Brains

“…Each BB has its own protocol. Except for particular studies, such as the bihemispheric cutting protocol of the Biomedical Research Institute (New Jersey) 29 and the Deramecourt's study of cerebrovascular pathology 30 , the biggest BBs in the world simply cut the cerebrum, cerebellum and brainstem along the midline (sagittal plane). One half is dissected fresh and then frozen for biochemical studies, while the other is fixed in formalin for histopathological assessment.…”