A brain autopsy is essential to obtain a definitive diagnosis of frontotemporal degeneration; however, the autopsy can be a difficult topic to face emotionally. It may not only help to resolve questions about diagnosis, but also offers family members a sense of closure. People who participate in a brain donation program should receive an autopsy report with pathology findings.
There are several important reasons why a family should consider arranging for a brain autopsy upon the death of their loved one.
To get a definitive diagnosis. While a patient is alive, the clinician uses the tools that are available to him or her (physical exam, CT, MRI scans, etc) to make the most accurate diagnosis possible. However, it is only by actually looking at the affected brain tissue that a pathologist can be able to see exactly what occurred in specific portions of the brain and correlate with the clinical picture of FTD. The pathological diagnosis that results from the autopsy is the official diagnosis of that patient’s disease.
To provide information for family members. Because some frontotemporal degeneration may be hereditary, the official diagnosis may have ramifications for the patient’s first-degree relatives. With this pathological diagnosis in hand, a genetic counselor can have a much more productive and informed discussion with the next of kin about the potential implications and risks for family members. Identification of a genetic mutation, if it exists, could become important for other family members, particularly if treatment becomes available in the future.
To improve clinical diagnostic techniques for future patients. Pathologists need to study the actual tissue to understand the biochemical and molecular changes that have taken place in the brain cells. They can then correlate these pathological changes with the data that was gathered via clinical testing during life (such as the symptoms, MRI, CT scans and other tools available to the clinician). This entire process helps the clinician to do a better job of interpreting the information they gather from these tests-and give future patients more accurate diagnosis in a more timely manner. Accurate and timely diagnosis will become increasingly important as more effective therapies are developed for FTD.
To better understand the disease process at work in FTD. It is only by increasing our basic understanding of what alteration affects the brain-and why-that researchers can design more targeted and effective therapies.
To remove the brain, an incision is made from the mastoid process behind the ear, extending coronally to the opposite mastoid.
Skin and muscle are reflected anteriorly to approximately 1cm above the eyebrows. The posterior scalp is reflected to the occipital protuberance.
The skullcap is cut with a bone saw following a line horizontally on both sides from the center of the forehead to the base of mastoid process.
A notch is usually cut at the center of the forehead to allow more stable repositioning of the skullcap.
The second cut is made over the posterior superior surface of the skull such that the angle from this cut to the first cut is more than ninety degrees.
The brain is removed by drawing back the frontal lobes. Optic nerves and carotid arteries are cut together with the pituitary stalk.
The temporal lobes are lifted and the tentorium is cut with scissors or a scalpel blade.
Cervical spine is then cut as far down as possible. The pituitary is removed by fracturing the sella turcica.