Brain-cutting device for correlation of brain scan and autopsy sections Technical note
FRED C. SHIPPS, M.D., ANTHONY D'AGOSTINO, M.D., AND JOHN RAAF, M.D. Departments of Diagnostic Radiology, Neuropathology, and Neurosurgery, Good Samaritan Hospital and Medical Center, Portland, Oregon
~" The authors describe a frame with guides to facilitate accurate correlation of the planes of brain-specimen sections with computerized axial tomography brain scans. KEY WORDS brain section
9
computerized axial tomography
N 1972 in England, Hounsfield2 and Ambrose 1 developed computerized axial tomography (CAT) for the evaluation of the brain. We have devised a method of brain cutting for use when correlation between CAT scans and autopsy specimens is desired. Free-hand specimen cutting to match the views of the CAT scans, if even roughly accurate, is time-consuming. The orbitomeatal line used clinically in determining the head position for the scan is lost after the autopsy. The levels of cuts and the various angles used during scanning further complicate the planes of free-hand cuts. The device we have developed holds the brain specimen in the desired position for ease and accuracy of cutting. The proper tilt and elevation can be achieved in a few seconds to correlate with the angle of the scan. The device guides a long knife along the planes of the CAT scan to produce smooth anatomical surfaces on the specimens.
I
J. Neurosurg. / Volume 44 / June, 1976
9 brain scan
Technique Figure 1 shows the orbitomeatal (O-M) line which is lost after separating the brain from the skull? Our O-M line is determined by the outer canthus of the eye and the auditory meatus. The occipitofrontal (O-F) line is drawn between the most inferior aspects of these lobes. The O-F line is used to align the brain specimen to the fixture for cutting. The CAT planes are illustrated by the dashed lines (Fig. 1 left), and correspond to the cutting slots in the lucite of the fixture (Fig. 1 right). The neuropathologist positions the specimen in the hole on the supporting plate (Fig. 1 right). The underside of the frontal and occipital lobes are approximately aligned to the corrected scan cutting angles; that is, the 0 ~ 15 ~ or 25 ~ lines. The knurled screws at either end of the supporting plate provide fine adjustment for elevation or depression of 759
F. C. Shipps, A. D'Agostino and J. Raaf
FIG. I. Left: Drawing of brain showing relationships of scan cuts, or device slots, to the frontooccipital line on the device. 1A, 1B, 2A, 2B, 3A, and 3B indicate the planes of the CAT scan. (Reproduced with permission from Shipps FC, Madeira JT, et al: Atlas of Brain Anatomy for EMI Scans. Springfield, II1: Charles C Thomas, 1975.) Right: Side view of device with brain specimen in position for cutting.
FIG. 2. Comparison of the postmortem brain cut using our fixture (right) and a corresponding CAT scan (left). This patient died as a result of multiple cerebral hematomas. Rupture of blood into the left anterior horn is demonstrated. either end of the plate.The brain is held with one hand and cuts are made with a knife held in the other hand, starting from the top down. Either right- or left-handed cuts are possible. Figure 2 shows the desirable correlation between a C A T scan and a cut brain specimen. References
1. Ambrose J: Computerized transverse axial scanning (tomography): Part 2. Clinical application. Br J Radiol 46:1012-1047, 1973 760
2. Hounsfield GN: Computerized transverse axial scanning (tomography): Part 1. Description of system. Br J Radiol 46:1016-1022, 1973 3. Shipps FC, Madeira JT, Huntington HW, et al: Atlas of Brain Anatomy for EMI Scans. Springfield, I11: Charles C Thomas, 1975
Address reprint requests to: Fred C. Shipps, M.D., Department of Diagnostic Radiology, Good Samaritan Hospital and Medical Center, Portland, Oregon 97210. J. Neurosurg. / Volume 44 / June, 1976
FRED C. SHIPPS, M.D., ANTHONY D'AGOSTINO, M.D., AND JOHN RAAF, M.D. Departments of Diagnostic Radiology, Neuropathology, and Neurosurgery, Good Samaritan Hospital and Medical Center, Portland, Oregon
~" The authors describe a frame with guides to facilitate accurate correlation of the planes of brain-specimen sections with computerized axial tomography brain scans. KEY WORDS brain section
9
computerized axial tomography
N 1972 in England, Hounsfield2 and Ambrose 1 developed computerized axial tomography (CAT) for the evaluation of the brain. We have devised a method of brain cutting for use when correlation between CAT scans and autopsy specimens is desired. Free-hand specimen cutting to match the views of the CAT scans, if even roughly accurate, is time-consuming. The orbitomeatal line used clinically in determining the head position for the scan is lost after the autopsy. The levels of cuts and the various angles used during scanning further complicate the planes of free-hand cuts. The device we have developed holds the brain specimen in the desired position for ease and accuracy of cutting. The proper tilt and elevation can be achieved in a few seconds to correlate with the angle of the scan. The device guides a long knife along the planes of the CAT scan to produce smooth anatomical surfaces on the specimens.
I
J. Neurosurg. / Volume 44 / June, 1976
9 brain scan
Technique Figure 1 shows the orbitomeatal (O-M) line which is lost after separating the brain from the skull? Our O-M line is determined by the outer canthus of the eye and the auditory meatus. The occipitofrontal (O-F) line is drawn between the most inferior aspects of these lobes. The O-F line is used to align the brain specimen to the fixture for cutting. The CAT planes are illustrated by the dashed lines (Fig. 1 left), and correspond to the cutting slots in the lucite of the fixture (Fig. 1 right). The neuropathologist positions the specimen in the hole on the supporting plate (Fig. 1 right). The underside of the frontal and occipital lobes are approximately aligned to the corrected scan cutting angles; that is, the 0 ~ 15 ~ or 25 ~ lines. The knurled screws at either end of the supporting plate provide fine adjustment for elevation or depression of 759
F. C. Shipps, A. D'Agostino and J. Raaf
FIG. I. Left: Drawing of brain showing relationships of scan cuts, or device slots, to the frontooccipital line on the device. 1A, 1B, 2A, 2B, 3A, and 3B indicate the planes of the CAT scan. (Reproduced with permission from Shipps FC, Madeira JT, et al: Atlas of Brain Anatomy for EMI Scans. Springfield, II1: Charles C Thomas, 1975.) Right: Side view of device with brain specimen in position for cutting.
FIG. 2. Comparison of the postmortem brain cut using our fixture (right) and a corresponding CAT scan (left). This patient died as a result of multiple cerebral hematomas. Rupture of blood into the left anterior horn is demonstrated. either end of the plate.The brain is held with one hand and cuts are made with a knife held in the other hand, starting from the top down. Either right- or left-handed cuts are possible. Figure 2 shows the desirable correlation between a C A T scan and a cut brain specimen. References
1. Ambrose J: Computerized transverse axial scanning (tomography): Part 2. Clinical application. Br J Radiol 46:1012-1047, 1973 760
2. Hounsfield GN: Computerized transverse axial scanning (tomography): Part 1. Description of system. Br J Radiol 46:1016-1022, 1973 3. Shipps FC, Madeira JT, Huntington HW, et al: Atlas of Brain Anatomy for EMI Scans. Springfield, I11: Charles C Thomas, 1975
Address reprint requests to: Fred C. Shipps, M.D., Department of Diagnostic Radiology, Good Samaritan Hospital and Medical Center, Portland, Oregon 97210. J. Neurosurg. / Volume 44 / June, 1976
