Twenty-first century brain banking: practical prerequisites and lessons from the past: the experience of New York Brain Bank, Taub Institute, Columbia University

Abstract

Generally accepted methods for processing postmortem brains are lacking, despite the efforts of pioneers in the field, and the growing awareness of the importance of brain banking for investigating the pathogenesis of illnesses unique to humans. Standardizing methods requires compromises, institutional or departmental mindset promoting collaboration, and the willingness to share ideas, information, and samples. A sound balance between competition and institutional interests is needed to best fulfill the tasks entrusted to health care institutions. Thus, a potentially widely accepted protocol design involves tradeoffs. We successfully integrated brain banking within the operation of the department of pathology. We reached a consensus whereby a brain can be utilized for diagnosis, research, and teaching. Thus, routing brains away from residency programs is avoided. The best diagnostic categorization possible is being secured and the yield of samples for research maximized. Thorough technical details pertaining to the actual processing of brains donated for research were recently published. Briefly, one-half of each brain is immersed in formalin for performing the neuropathologic evaluation, which is combined with the teaching task. The contralateral half is extensively dissected at the fresh state to obtain samples ready for immediate disbursement once categorized diagnostically. The samples are tracked electronically, which is crucial. This important tracking system is described separately in this issue. This report focuses on key lessons learned over the past 25 years of brain banking including successful solutions to originally unforeseen problems.

Fig 1

Results are often disappointing when brains are harvested outside the institution harboring the brain bank facilities, and when they are partially processed at the site of the autopsy by untrained prosectors (a – c). Uninitiated prosectors cut fresh brains regardless of their anatomical landmarks. The internal structures of the coronal slab (b) are no longer identifiable. Therefore, the presence or absence of gross lesions cannot be ruled out. Even a single requirement of splitting the brain sagittaly through the corpus callosum followed by the freezing of one half resulted in severe distortion (c). Anatomically and pathologically unidentifiable frozen part of a brain wrapped with aluminum foil (d).

Fig 1

Results are often disappointing when brains are harvested outside the institution harboring the brain bank facilities, and when they are partially processed at the site of the autopsy by untrained prosectors (a – c). Uninitiated prosectors cut fresh brains regardless of their anatomical landmarks. The internal structures of the coronal slab (b) are no longer identifiable. Therefore, the presence or absence of gross lesions cannot be ruled out. Even a single requirement of splitting the brain sagittaly through the corpus callosum followed by the freezing of one half resulted in severe distortion (c). Anatomically and pathologically unidentifiable frozen part of a brain wrapped with aluminum foil (d).

Fig 1

Results are often disappointing when brains are harvested outside the institution harboring the brain bank facilities, and when they are partially processed at the site of the autopsy by untrained prosectors (a – c). Uninitiated prosectors cut fresh brains regardless of their anatomical landmarks. The internal structures of the coronal slab (b) are no longer identifiable. Therefore, the presence or absence of gross lesions cannot be ruled out. Even a single requirement of splitting the brain sagittaly through the corpus callosum followed by the freezing of one half resulted in severe distortion (c). Anatomically and pathologically unidentifiable frozen part of a brain wrapped with aluminum foil (d).

Fig 1

Results are often disappointing when brains are harvested outside the institution harboring the brain bank facilities, and when they are partially processed at the site of the autopsy by untrained prosectors (a – c). Uninitiated prosectors cut fresh brains regardless of their anatomical landmarks. The internal structures of the coronal slab (b) are no longer identifiable. Therefore, the presence or absence of gross lesions cannot be ruled out. Even a single requirement of splitting the brain sagittaly through the corpus callosum followed by the freezing of one half resulted in severe distortion (c). Anatomically and pathologically unidentifiable frozen part of a brain wrapped with aluminum foil (d).

Fig 2

Example of a brain harvested in Kansas City by a local pathologist. The intact, fresh brain was inserted within tightly closed plastic bags, placed on wet ice, and then shipped to the NYBB, where it was photographed, at the time of its reception (a). The left half was banked (b). The coronal slabs obtained are free of distortion. The striatum and amygdala (c) or the thalamus and mammillothalamic tract are distinct (d). On gross examination, a thorough and reliable evaluation can be performed.

Fig 2

Example of a brain harvested in Kansas City by a local pathologist. The intact, fresh brain was inserted within tightly closed plastic bags, placed on wet ice, and then shipped to the NYBB, where it was photographed, at the time of its reception (a). The left half was banked (b). The coronal slabs obtained are free of distortion. The striatum and amygdala (c) or the thalamus and mammillothalamic tract are distinct (d). On gross examination, a thorough and reliable evaluation can be performed.

Fig 2

Example of a brain harvested in Kansas City by a local pathologist. The intact, fresh brain was inserted within tightly closed plastic bags, placed on wet ice, and then shipped to the NYBB, where it was photographed, at the time of its reception (a). The left half was banked (b). The coronal slabs obtained are free of distortion. The striatum and amygdala (c) or the thalamus and mammillothalamic tract are distinct (d). On gross examination, a thorough and reliable evaluation can be performed.

Fig 2

Example of a brain harvested in Kansas City by a local pathologist. The intact, fresh brain was inserted within tightly closed plastic bags, placed on wet ice, and then shipped to the NYBB, where it was photographed, at the time of its reception (a). The left half was banked (b). The coronal slabs obtained are free of distortion. The striatum and amygdala (c) or the thalamus and mammillothalamic tract are distinct (d). On gross examination, a thorough and reliable evaluation can be performed.

Fig 3

Coronal slab of a seven month-old baby girl diagnosed with spino-muscular atrophy (a). A block including the lenticular nucleus with insula, and a block including the thalamus were obtained from (a), and then frozen at – 180 ° C (b). Two transverse blocks of the mesencephalon are shown fresh (c), and frozen (d). Note the absence of pigment of the pars compacta of the substantia nigra, as normally expected at that age.

Fig 3

Coronal slab of a seven month-old baby girl diagnosed with spino-muscular atrophy (a). A block including the lenticular nucleus with insula, and a block including the thalamus were obtained from (a), and then frozen at – 180 ° C (b). Two transverse blocks of the mesencephalon are shown fresh (c), and frozen (d). Note the absence of pigment of the pars compacta of the substantia nigra, as normally expected at that age.

Fig 3

Coronal slab of a seven month-old baby girl diagnosed with spino-muscular atrophy (a). A block including the lenticular nucleus with insula, and a block including the thalamus were obtained from (a), and then frozen at – 180 ° C (b). Two transverse blocks of the mesencephalon are shown fresh (c), and frozen (d). Note the absence of pigment of the pars compacta of the substantia nigra, as normally expected at that age.

Fig 3

Coronal slab of a seven month-old baby girl diagnosed with spino-muscular atrophy (a). A block including the lenticular nucleus with insula, and a block including the thalamus were obtained from (a), and then frozen at – 180 ° C (b). Two transverse blocks of the mesencephalon are shown fresh (c), and frozen (d). Note the absence of pigment of the pars compacta of the substantia nigra, as normally expected at that age.