**5.1 Method of removal of organs**

Evisceration and Block Dissection equipment*:* It is essential to have a selection of small forceps, scissors, and probes, in addition to a scalpel. A pair of scales accurate at low weights is also necessary. Of all the methods used for eviscerate a foetus, the most common would be the method of Letulle, in which all organs are removed en bloc with the advantage of keeping continuity if malformations are suspected [2]. Alternate techniques for evisceration and dissection include Ghon, which removes the organs in functional "blocks" and Virchow and Rokitansky techniques [2]. Rokinansky method is an in-situ examination of viscera with removal of notable organs. Virchow method is an organ by organ removal.

Initial Stages of Evisceration: the best incision involves an inverted Y, with a central cut from below the chin to just above the umbilicus and then two branches, one down to each inguinal fossa which allows a good exposure of the umbilical arteries.

During reflection the scalp, note whether there is any subaponeurotic haemorrhage to exclude asphyxia or deep bruises (**Figure 2**).

Procedure: In foetuses and infants, Beneke's technique is used to open the skull. The cranium and dura on both the sides are cut with blunt scissors starting at the lateral edge of the anterior fontanelle extending the incisions along the midline and the lateral sides of the skull. The midline strip about 1 cm wide containing the superior sagittal sinus and the falx is left, and also an intact area in the temporal squama on either side, which serves as a hinge when the bone is reflected in a 'butterfly' manner [6].

An alternative method of cutting which follows the cranial suture lines i.e. Rokitansky's method [4]. After carefully inspecting the hemispheres, falx cerebri and tentorium cerebelli through the openings, the midline bone and sinus are removed. Injuries to fontanelles (e.g. punctured wounds through anterior fontanelle) and subdural/subarachnoid haemorrhages are looked for [6] (**Figure 3**).

#### **5.2 Removal of the brain of a macerated baby**

If the dura is left intact when the skull plates are cut, and carefully dissected from the skull when the bone flaps are reflected, then the entire brain can be removed while intact inside the dura.

#### **5.3 Removal of the brain in a case of cystic congenital anomalies**

It is better to fix the brain before removal of these anomalies. A CSF needle can be used to extract CSF from the ventricles which then can be filled with 50 ml of formalin. An hour of fixation of the brain would help it in maintaining its shape, whereupon removal of the anomaly can be done. If contrast mixture is mixed with the formalin then X-ray films can be taken that will outline the ventricular system [2].

#### **5.4 Removal of the spinal cord in a suspected neural tube defect**

The best method is the posterior approach. The skin is incised and at the point of the defect an ellipse shaped piece of the skin is removed, which completely encircles

**Figure 2.** *Removal of the brain.*

**Figure 3.** *Opening of skull and dissection of underlying dura and brain.*

the defect. When the pedicles have been cut above and below the defect with bony forceps, the cord is removed. Once the cord has been removed above and below the defect, the vertebral column can be transacted. This can be fixed and examined histologically after serial sectioning. The resulting skin defect should be covered.
