Methods to open the skull at Autopsy: An analysis

During a medico-legal autopsy, a forensic pathologist opens the skull wide at bony landmarks for better access into the cranial cavity. This helps to observe the intracranial findings of medicolegal significance and to remove the brain intact for better assessment of the findings. The various methods for opening the skull available, include-use of hammer and chisel, manual saw or electric saw; each with its own advantages and disadvantages. Comparison of time, effort and skill required for each of these methods and in the current scenario, the possibility of risk of acquisition of multi-drug resistant tuberculosis (MDR TB) or HIV infection from the deceased is being discussed. One significant issue associated with hammer and chisel method used for opening the skull includes either extension or creation of fractures (artefacts). This can be minimised by limiting the use of hammer and chisel in opening the skull. A vibrating electric saw with vacuum aspirator or bone dust collector is recommended for opening the skull for autopsies. If the facility of vacuum aspirator or bone dust collector is not available, other methods of opening the skull as compared to use of electric saw would be safer in terms of risk of exposure to MDR TB, HIV infections or others which could spread by bone aerosol generation.