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Trepanning, also known as trepanation, trephination, trephining or making a burr hole (the verb ''trepan'' derives from
Old French
Old French (, , ; Modern French: ) was the language spoken in most of the northern half of France from approximately the 8th to the 14th centuries. Rather than a unified language, Old French was a linkage of Romance dialects, mutually intelligib ...
from
Medieval Latin
Medieval Latin was the form of Literary Latin used in Roman Catholic Western Europe during the Middle Ages. In this region it served as the primary written language, though local languages were also written to varying degrees. Latin functioned ...
from
Greek
Greek may refer to:
Greece
Anything of, from, or related to Greece, a country in Southern Europe:
*Greeks, an ethnic group.
*Greek language, a branch of the Indo-European language family.
**Proto-Greek language, the assumed last common ancestor ...
, literally "borer, auger"), is a surgical intervention in which a hole is
drilled or scraped into the
human skull
The skull is a bone protective cavity for the brain. The skull is composed of four types of bone i.e., cranial bones, facial bones, ear ossicles and hyoid bone. However two parts are more prominent: the cranium and the mandible. In humans, the ...
. The intentional perforation of the cranium exposes the ''
dura mater
In neuroanatomy, dura mater is a thick membrane made of dense irregular connective tissue that surrounds the brain and spinal cord. It is the outermost of the three layers of membrane called the meninges that protect the central nervous system. ...
'' to treat health problems related to intracranial diseases or release pressured blood buildup from an injury. It may also refer to any "burr" hole created through other body surfaces, including nail beds. A
trephine
A trephine (; from Greek ''trypanon'', meaning an instrument for boring). is a surgical instrument with a cylindrical blade. It can be of one of several dimensions and designs depending on what it is meant to be used for. They may be specially d ...
is an instrument used for cutting out a round piece of skull bone to relieve pressure beneath a surface.
In ancient times, holes were drilled into a person who was behaving in what was considered an abnormal way to let out what people believed were evil spirits. Evidence of trepanation has been found in prehistoric human remains from
Neolithic
The Neolithic period, or New Stone Age, is an Old World archaeological period and the final division of the Stone Age. It saw the Neolithic Revolution, a wide-ranging set of developments that appear to have arisen independently in several parts ...
times onward. The bone that was trepanned was kept by the prehistoric people and may have been worn as a charm to keep evil spirits away. Evidence also suggests that trepanation was primitive emergency surgery after head wounds
to remove shattered bits of bone from a fractured skull and clean out the blood that often pools under the skull after a blow to the head. Hunting accidents, falls, wild animals, and weapons such as clubs or spears could have caused such injuries. Trepanations appear to have been most common in areas where weapons that could produce skull fractures were used.
The primary theories for the practice of trepanation in ancient times include spiritual purposes and treatment for epilepsy, head wound, mental disorders, and headache, although the latter may be just an unfounded myth.
In modern eye surgery, a trephine instrument is used in
corneal transplant surgery. The procedure of drilling a hole through a fingernail or toenail is also known as trephination. It is performed by a physician or surgeon to relieve the pain associated with a
subungual hematoma
A subungual hematoma is a collection of blood (hematoma) underneath a toenail or fingernail. It can be extremely painful for an injury of its size, although otherwise it is not a serious medical condition.
Nature
A laceration of the nail bed c ...
(blood under the nail); a small amount of blood is expressed through the hole and the pain associated with the pressure is partially alleviated. Similarly, in abdominal surgery, a trephine incision is when a small disc of abdominal skin is excised to accommodate a
stoma
In botany, a stoma (from Greek ''στόμα'', "mouth", plural "stomata"), also called a stomate (plural "stomates"), is a pore found in the epidermis of leaves, stems, and other organs, that controls the rate of gas exchange. The pore is bor ...
. Although the abdominal wall does not contain bone, the use of the word ''trephine'' in this context may relate to the round excised area of skin being similar in shape to a
burr hole.
History
Prehistoric evidence
Trepanation dates back to 7,000–10,000 years ago,
and it is perhaps the oldest surgical procedure for which there is
archaeological
Archaeology or archeology is the scientific study of human activity through the recovery and analysis of material culture. The archaeological record consists of artifacts, architecture, biofacts or ecofacts, sites, and cultural landscap ...
evidence, and in some areas may have been quite widespread. The main pieces of archaeological evidence are in the forms of cave paintings and human remains. At one burial site in
France
France (), officially the French Republic ( ), is a country primarily located in Western Europe. It also comprises of Overseas France, overseas regions and territories in the Americas and the Atlantic Ocean, Atlantic, Pacific Ocean, Pac ...
dated to 6500 BCE, 40 out of 120
prehistoric
Prehistory, also known as pre-literary history, is the period of human history between the use of the first stone tools by hominins 3.3 million years ago and the beginning of recorded history with the invention of writing systems. The use of ...
skulls found had trepanation holes.
At the time only around 40% of people survived the procedure.
More than 1,500 trephined skulls from the Neolithic period (representing 5 to 10% of all Stone Age skulls) have been uncovered throughout the worldfrom Europe,
Siberia
Siberia ( ; rus, Сибирь, r=Sibir', p=sʲɪˈbʲirʲ, a=Ru-Сибирь.ogg) is an extensive geographical region, constituting all of North Asia, from the Ural Mountains in the west to the Pacific Ocean in the east. It has been a part of ...
, China and
the Americas
The Americas, which are sometimes collectively called America, are a landmass comprising the totality of North America, North and South America. The Americas make up most of the land in Earth's Western Hemisphere and comprise the New World. ...
. Most of the trephined crania belong to adult males, but women and children are also represented.
There also exists evidence of trepanation being performed on a cow in France around 3400-3000 BCE. If performed while alive, the cow did not survive the procedure. It is unclear if this was performed as a
veterinary procedure,
medical experimentation
Clinical trials are prospective biomedical or behavioral research studies on human participants designed to answer specific questions about biomedical or behavioral interventions, including new treatments (such as novel vaccines, drugs, dietar ...
, or for another reason. It would be the earliest archaeological example of veterinary surgery or animal medical experimentation if those were the reasons.
Pre-Columbian Mesoamerica
In the more recent times of
postclassical
In world history, post-classical history refers to the period from about 500 AD to 1500, roughly corresponding to the European Middle Ages. The period is characterized by the expansion of civilizations geographically and development of trade n ...
pre-Columbian
In the history of the Americas, the pre-Columbian era spans from the original settlement of North and South America in the Upper Paleolithic period through European colonization, which began with Christopher Columbus's voyage of 1492. Usually, th ...
Mesoamerica
Mesoamerica is a historical region and cultural area in southern North America and most of Central America. It extends from approximately central Mexico through Belize, Guatemala, El Salvador, Honduras, Nicaragua, and northern Costa Rica. W ...
, evidence for the practice of trepanation and an assortment of other
cranial
Standard anatomical terms of location are used to unambiguously describe the anatomy of animals, including humans. The terms, typically derived from Latin or Greek roots, describe something in its standard anatomical position. This position pro ...
deformation techniques comes from a variety of sources, including physical cranial remains of burials, allusions in iconographic artworks and reports from the post-colonial period.
Among
New World
The term ''New World'' is often used to mean the majority of Earth's Western Hemisphere, specifically the Americas."America." ''The Oxford Companion to the English Language'' (). McArthur, Tom, ed., 1992. New York: Oxford University Press, p. 3 ...
societies, trepanning is most commonly found in the
Andean
The Andes, Andes Mountains or Andean Mountains (; ) are the longest continental mountain range in the world, forming a continuous highland along the western edge of South America. The range is long, wide (widest between 18°S – 20°S l ...
civilizations, such as pre-
Incan
The Inca Empire (also known as the Incan Empire and the Inka Empire), called ''Tawantinsuyu'' by its subjects, (Quechua for the "Realm of the Four Parts", "four parts together" ) was the largest empire in pre-Columbian America. The admin ...
cultures. For example, the Paracas culture
Ica, situated in what is now known as Ica, located south of Lima. Trepanation has also been found in the
Muisca Confederation (in modern-day Colombia) and the
Inca Empire
The Inca Empire (also known as the Incan Empire and the Inka Empire), called ''Tawantinsuyu'' by its subjects, (Quechua for the "Realm of the Four Parts", "four parts together" ) was the largest empire in pre-Columbian America. The admin ...
. In both, even
cranioplasty
Cranioplasty is a surgical operation on the repairing of cranial defects caused by previous injuries or operations, such as decompressive craniectomy. It is performed by filling the defective area with a range of materials, usually a bone piece ...
existed. The prevalence of trepanation among Mesoamerican civilizations is much lower, at least judging from the comparatively few trepanned crania that have been uncovered.
The
archaeological record
The archaeological record is the body of physical (not written) evidence about the past. It is one of the core concepts in archaeology, the academic discipline concerned with documenting and interpreting the archaeological record. Archaeological t ...
in Mesoamerica is further complicated by the practice of skull mutilation and modification carried out ''after'' the death of the subject, to fashion "trophy skulls" and the like of captives and enemies. This was a widespread tradition, illustrated in pre-Columbian art that occasionally depicts rulers adorned with or carrying the modified skulls of their defeated enemies, or of the ritualistic display of
sacrificial
Sacrifice is the offering of material possessions or the lives of animals or humans to a deity as an act of propitiation or worship. Evidence of ritual animal sacrifice has been seen at least since ancient Hebrews and Greeks, and possibly ex ...
victims. Several Mesoamerican cultures used a skull-rack (known by its
Nahuatl
Nahuatl (; ), Aztec, or Mexicano is a language or, by some definitions, a group of languages of the Uto-Aztecan language family. Varieties of Nahuatl are spoken by about Nahua peoples, most of whom live mainly in Central Mexico and have smaller ...
term, ''
tzompantli
A () or skull rack was a type of wooden rack or palisade documented in several Mesoamerican civilizations, which was used for the public display of human skulls, typically those of war captives or other sacrificial victims. It is a scaffold-l ...
''), on which skulls were impaled in rows or columns of wooden stakes. Even so, some evidence of genuine trepanation in Mesoamerica (i.e., where the subject was living) has survived.
The earliest archaeological survey published of trepanned crania was a late 19th-century study of several specimens recovered from the
Tarahumara mountains by the Norwegian
ethnographer
Ethnography (from Greek ''ethnos'' "folk, people, nation" and ''grapho'' "I write") is a branch of anthropology and the systematic study of individual cultures. Ethnography explores cultural phenomena from the point of view of the subject o ...
Carl Lumholtz
Carl Sofus Lumholtz (23 April 1851 – 5 May 1922) was a Norwegian explorer and ethnographer, best known for his meticulous field research and ethnographic publications on indigenous cultures of Australia and Mexico.
Biography
Born in Fåberg, N ...
.
Later studies documented cases identified from a range of sites in
Oaxaca
Oaxaca ( , also , , from nci, Huāxyacac ), officially the Free and Sovereign State of Oaxaca ( es, Estado Libre y Soberano de Oaxaca), is one of the 32 states that compose the political divisions of Mexico, Federative Entities of Mexico. It is ...
and central
Mexico
Mexico (Spanish: México), officially the United Mexican States, is a country in the southern portion of North America. It is bordered to the north by the United States; to the south and west by the Pacific Ocean; to the southeast by Guatema ...
, such as
Tilantongo
Tilantongo was a Mixtec citystate in the Mixteca Alta region of the modern-day state of Oaxaca which is now visible as an archeological site and a modern town of Santiago Tilantongo. It is located at 17°15' N. Lat. and 97°17' W. Long. Its Mix ...
, Oaxaca and the major
Zapotec site of
Monte Albán
Monte Albán is a large pre-Columbian archaeological site in the Santa Cruz Xoxocotlán Municipality in the southern Mexican state of Oaxaca (17.043° N, 96.767°W). The site is located on a low mountainous range rising above the plain in the ...
. Two specimens from the
Tlatilco
Tlatilco was a large pre-Columbian village in the Valley of Mexico situated near the modern-day town of the same name in the Mexican Federal District. It was one of the first chiefdom centers to arise in the Valley, flourishing on the western sho ...
civilization's homelands (which flourished around 1400 BCE) indicate the practice has a lengthy tradition.
A study of ten low-status burials from the
Late Classic period at
Monte Albán
Monte Albán is a large pre-Columbian archaeological site in the Santa Cruz Xoxocotlán Municipality in the southern Mexican state of Oaxaca (17.043° N, 96.767°W). The site is located on a low mountainous range rising above the plain in the ...
concluded that the trepanation had been applied non-therapeutically. Since multiple techniques had been used and since some people had received more than one trepanation, the conclusion became that trepanning had been done experimentally. Inferring the events to represent experiments on people until they died, the study interpreted that use of trepanation as an indicator of the stressful sociopolitical climate that not long thereafter resulted in the abandonment of Monte Alban as the primary regional administrative center in the
Oaxaca
Oaxaca ( , also , , from nci, Huāxyacac ), officially the Free and Sovereign State of Oaxaca ( es, Estado Libre y Soberano de Oaxaca), is one of the 32 states that compose the political divisions of Mexico, Federative Entities of Mexico. It is ...
n highlands.
Specimens identified from the
Maya civilization
The Maya civilization () of the Mesoamerican people is known by its ancient temples and glyphs. Its Maya script is the most sophisticated and highly developed writing system in the pre-Columbian Americas. It is also noted for its art, archit ...
region of southern Mexico,
Guatemala
Guatemala ( ; ), officially the Republic of Guatemala ( es, República de Guatemala, links=no), is a country in Central America. It is bordered to the north and west by Mexico; to the northeast by Belize and the Caribbean; to the east by H ...
and the
Yucatán Peninsula
The Yucatán Peninsula (, also , ; es, Península de Yucatán ) is a large peninsula in southeastern Mexico and adjacent portions of Belize and Guatemala. The peninsula extends towards the northeast, separating the Gulf of Mexico to the north ...
show no evidence of the drilling or cutting techniques found in central and highland Mexico. Instead, the pre-Columbian Maya apparently used an abrasive technique that ground away at the back of the skull, thinning the bone and sometimes perforating it, similar to the examples from Cholula. Many skulls from the Maya region date from the Postclassic period (), and include specimens found at
Palenque
Palenque (; Yucatec Maya language, Yucatec Maya: ), also anciently known in the Itza Language as Lakamhaʼ ("Big Water or Big Waters"), was a Maya city City-state, state in southern Mexico that perished in the 8th century. The Palenque ruins dat ...
in
Chiapas
Chiapas (; Tzotzil language, Tzotzil and Tzeltal language, Tzeltal: ''Chyapas'' ), officially the Free and Sovereign State of Chiapas ( es, Estado Libre y Soberano de Chiapas), is one of the states that make up the Political divisions of Mexico, ...
, and recovered from the
Sacred Cenote
The Sacred Cenote ( es, cenote sagrado, , "sacred well"; alternatively known as the "Well of Sacrifice") is a water-filled sinkhole in limestone at the pre-Columbian Maya archaeological site of Chichen Itza, in the northern Yucatán Peninsula. It ...
at the prominent Postclassic site of
Chichen Itza
Chichen Itza , es, Chichén Itzá , often with the emphasis reversed in English to ; from yua, Chiʼchʼèen Ìitshaʼ () "at the mouth of the well of the Itza people" was a large pre-Columbian city built by the Maya people of the Terminal ...
in northern Yucatán.
Ancient China
Before 2007, archaeological evidence of trepanation in ancient China was nonexistent. Since Chinese culture mainly focuses only on
traditional Chinese medicine
Traditional Chinese medicine (TCM) is an alternative medical practice drawn from traditional medicine in China. It has been described as "fraught with pseudoscience", with the majority of its treatments having no logical mechanism of action ...
that usually entails non-surgical treatments such as
acupuncture
Acupuncture is a form of alternative medicine and a component of traditional Chinese medicine (TCM) in which thin needles are inserted into the body. Acupuncture is a pseudoscience; the theories and practices of TCM are not based on scientif ...
, balancing
Qigong
''Qigong'' (), ''qi gong'', ''chi kung'', ''chi 'ung'', or ''chi gung'' () is a system of coordinated body-posture and movement, breathing, and meditation
used for the purposes of health, spirituality, and martial-arts training. With roots in ...
,
cupping,
herbal remedies
Herbal medicine (also herbalism) is the study of pharmacognosy and the use of medicinal plants, which are a basis of traditional medicine. With worldwide research into pharmacology, some herbal medicines have been translated into modern remedies ...
, etc. The resulting misconception was that trepanation was not practiced in ancient China. However, in 2007, Han and Chen from the Institute of Archeology,
Chinese Academy of Social Sciences
The Chinese Academy of Social Sciences (CASS) is a Chinese research institute and think tank. The institution is the premier comprehensive national academic research organization in the People's Republic of China for the study in the fields of ...
looked at six trepanned skulls spanning between the Neolithic period through the Bronze and Iron Ages ( years ago) found in five different locations.
Along with the discovery of these trepanned skulls, another collection of 13 trepanned skulls was discovered and dated to 3,000 years ago.
In 2015, an intact 3,600-year-old
mummy
A mummy is a dead human or an animal whose soft tissues and organs have been preserved by either intentional or accidental exposure to chemicals, extreme cold, very low humidity, or lack of air, so that the recovered body does not decay fu ...
with a trepanned skull was discovered. Meanwhile, the oldest trepanned skull (M382) analysed by Han and Chen was radiocarbon dated to around 5,000 years ago and discovered at the Fuija site in
Guangrao
Guangrao County () is a county of Dongying City in north-central Shandong province, People's Republic of China. The southernmost county-level division of Dongying City, it lies halfway between the downtowns of Zibo
Zibo (, ) is a prefecture ...
,
Shandong
Shandong ( , ; ; alternately romanized as Shantung) is a coastal province of the People's Republic of China and is part of the East China region.
Shandong has played a major role in Chinese history since the beginning of Chinese civilizati ...
. The skull, which belonged to an adult male, exhibited a right
parietal calvarial defect (31 x 25 mm) with evidence of scraping by a
trephine
A trephine (; from Greek ''trypanon'', meaning an instrument for boring). is a surgical instrument with a cylindrical blade. It can be of one of several dimensions and designs depending on what it is meant to be used for. They may be specially d ...
-like tool.
Additionally, bone regeneration and smooth edges suggest that the subject recovered from the surgery and lived a relatively long time afterward.
The 3,600-year-old perforated skull of a mummified female dating to 1615 BCE was found in the
Xiaohe tomb in China's
Xinjiang Uygur Autonomous Region
Xinjiang, SASM/GNC: ''Xinjang''; zh, c=, p=Xīnjiāng; formerly romanized as Sinkiang (, ), officially the Xinjiang Uygur Autonomous Region (XUAR), is an autonomous region of the People's Republic of China (PRC), located in the northwest ...
.
The only known female with a trepanned skull, it showed signs of bone spurs growth and retraction of the edges, suggesting that she also survived the surgery. Found in a massive burial site, this mummy was one of the hundreds found in the "Little River" Tomb complex.
The Bronze Age was found to be the period with the largest number of trepanned skulls in ancient China.
Medieval East Africa
Trephining has a long history in
East Africa
East Africa, Eastern Africa, or East of Africa, is the eastern subregion of the African continent. In the United Nations Statistics Division scheme of geographic regions, 10-11-(16*) territories make up Eastern Africa:
Due to the historical ...
. Bones of depressed fractures were elevated by surgeons of
Bunyoro-Kitara
Bunyoro or Bunyoro-Kitara is a Bantu kingdom in Western Uganda. It was one of the most powerful kingdoms in Central and East Africa from the 13th century to the 19th century. It is ruled by the King ('' Omukama'') of Bunyoro-Kitara. The cur ...
.
The hair may or may not have been shaved depending upon the site of the operation.
Trepanning at the
Kisii people
The Abagusii (also known as Kisii (Mkisii/Wakisii) in Swahili, or Gusii in Ekegusii) are a highly diverse East African ethnic group and nation indigenous to Kisii (formerly Kisii District) and Nyamira counties of former Nyanza, as well as p ...
in Kenya was filmed in 1958.
Pre-modern Europe
Trepanation was also practised in the classical and
Renaissance
The Renaissance ( , ) , from , with the same meanings. is a period in European history marking the transition from the Middle Ages to modernity and covering the 15th and 16th centuries, characterized by an effort to revive and surpass ideas ...
periods.
Hippocrates
Hippocrates of Kos (; grc-gre, Ἱπποκράτης ὁ Κῷος, Hippokrátēs ho Kôios; ), also known as Hippocrates II, was a Greek physician of the classical period who is considered one of the most outstanding figures in the history of ...
gave specific directions on the procedure from its evolution through the Greek age, and
Galen
Aelius Galenus or Claudius Galenus ( el, Κλαύδιος Γαληνός; September 129 – c. AD 216), often Anglicized as Galen () or Galen of Pergamon, was a Greek physician, surgeon and philosopher in the Roman Empire. Considered to be one of ...
also elaborates on the procedure. During the
Middle Ages
In the history of Europe, the Middle Ages or medieval period lasted approximately from the late 5th to the late 15th centuries, similar to the post-classical period of global history. It began with the fall of the Western Roman Empire a ...
and the
Renaissance
The Renaissance ( , ) , from , with the same meanings. is a period in European history marking the transition from the Middle Ages to modernity and covering the 15th and 16th centuries, characterized by an effort to revive and surpass ideas ...
, trepanation was practiced as a cure for various ailments, including seizures and skull fractures. Out of eight skulls with trepanations from the 6th to 8th centuries found in southwestern
Germany
Germany,, officially the Federal Republic of Germany, is a country in Central Europe. It is the second most populous country in Europe after Russia, and the most populous member state of the European Union. Germany is situated betwe ...
, seven skulls show clear evidence of healing and survival after trepanation, suggesting that the survival rate of the operations was high and the infection rate was low.
In the graveyards of pre-Christian (
Pagan
Paganism (from classical Latin ''pāgānus'' "rural", "rustic", later "civilian") is a term first used in the fourth century by early Christians for people in the Roman Empire who practiced polytheism, or ethnic religions other than Judaism. ...
)
Magyars, archeologists found a surprisingly high frequency (12.5%) of skulls with trepanation, although more than 90% only partial (these served probably ritual purposes). The trepanation was performed on adults only, with similar frequencies for males and females, but increasing frequency with age and wealth. This custom suddenly disappeared with the
Magyars' conversion to Christianity.
A small area near (modern)
Rostov-on-Don
Rostov-on-Don ( rus, Ростов-на-Дону, r=Rostov-na-Donu, p=rɐˈstof nə dɐˈnu) is a port city and the administrative centre of Rostov Oblast and the Southern Federal District of Russia. It lies in the southeastern part of the East Eu ...
, in southern Russia, may have been a centre for ritual trepanning, around 6000 years ago, according to archeologists who discovered remains of eight recipients of the practice, within a small area, all with the incision in the unusual
obelion
The term obelion is applied to that point of the sagittal suture which is on a level with the parietal foramina
A parietal foramen is an opening in the skull for the parietal emissary vein, which drains into the superior sagittal sinus. Occasion ...
position, high on the back of the head.
During the 16th and 17th centuries, around 80% of people survived the procedure of trepanation.
Modern medical practices
The prefrontal leucotomy, a precursor to
lobotomy
A lobotomy, or leucotomy, is a form of neurosurgical treatment for psychiatric disorder or neurological disorder (e.g. epilepsy) that involves severing connections in the brain's prefrontal cortex. The surgery causes most of the connections t ...
, was performed by cutting a
trephine
A trephine (; from Greek ''trypanon'', meaning an instrument for boring). is a surgical instrument with a cylindrical blade. It can be of one of several dimensions and designs depending on what it is meant to be used for. They may be specially d ...
hole into the skull, inserting an instrument, and destroying parts of the brain.
This was later made unnecessary by the development of the
orbital transit lobotomy where a spike was inserted through the eye-sockets.
Trepanation is a treatment used for
epidural
Epidural administration (from Ancient Greek ἐπί, , upon" + ''dura mater'') is a method of medication administration in which a medicine is injected into the epidural space around the spinal cord. The epidural route is used by physicians an ...
and
subdural hematoma
A subdural hematoma (SDH) is a type of bleeding in which a collection of blood—usually but not always associated with a traumatic brain injury—gathers between the inner layer of the dura mater and the arachnoid mater of the meninges surround ...
s, and surgical access for certain other neurosurgical procedures, such as intracranial pressure monitoring. Modern surgeons generally use the term ''
craniotomy
A craniotomy is a surgical operation in which a bone flap is temporarily removed from the skull to access the brain. Craniotomies are often critical operations, performed on patients who are suffering from brain lesions, such as tumors, blood clot ...
'' for this procedure. However, unlike our ancestors, craniotomy must be done after diagnostic imaging (which included
computed tomography and
magnetic resonance imaging
Magnetic resonance imaging (MRI) is a medical imaging technique used in radiology to form pictures of the anatomy and the physiological processes of the body. MRI scanners use strong magnetic fields, magnetic field gradients, and radio wave ...
) pinpointed the issues within the brain. The preoperative imaging allows for accurate examination and evaluation. Unlike trepanation, the removed piece of skull is typically replaced as soon as possible. Trepanation instruments, nowadays being replaced with
cranial drill
A cranial drill, also known as a craniotome, is a tool for drilling simple burr holes (trepanation) or for creating larger openings in the skull. This exposes the brain and allows operations like craniotomy and craniectomy to be done. The dril ...
s, are now available with diamond-coated rims, which are less traumatic than the classical trephines with sharp teeth. They are smooth to soft tissues and cut only bone.
Additionally, the specially designed drills come with a safety feature that prevents the drill from penetrating into the brain tissue (through the dura mater). Along with antisepsis and prophylaxis of infection, modern neurosurgery is a common procedure for many reasons other than head trauma.
In 20th century, in documented trepanning cases in Africa and Oceania, around 90% of people survived the procedure.
The false myth of trepanation as a treatment for headaches
After the retrieval of some skulls from the Neolithic era that showed signs of trepanation, in the XIX century, the false belief that these holes were drilled for the treatment of headaches or othe neurological disorders started spreading. During the 1870s, the French anthropologist and physician
Paul Broca
Pierre Paul Broca (, also , , ; 28 June 1824 – 9 July 1880) was a French physician, anatomist and anthropologist. He is best known for his research on Broca's area, a region of the frontal lobe that is named after him. Broca's area is involve ...
found several European and South American children’s skulls coming from the Neolithic age that were perforated surgically. Since no signs of fractures that could justify this complex procedure to relieve trauma were found, a debate flared to determine why these children were subjected to trepanation while they were still alive. Broca theorized that this operation had a ritual or religious purpose, probably to remove “confined demons” inside the head of the patient, or to create healing or fortune talismans with the removed skull fragments. However, he also suggested that the operation may have been performed to treat some infantile conditions such as febrile seizures to explain why it was performed only on children.
Broca never mentioned headaches, though, and the association was established only several decades later by the world-famous Canadian physician
William Osler
Sir William Osler, 1st Baronet, (; July 12, 1849 – December 29, 1919) was a Canadian physician and one of the "Big Four" founding professors of Johns Hopkins Hospital. Osler created the first residency program for specialty training of phys ...
, in 1913. Osler misinterpreted Broca's words, and added other conditions such as “''infantile convulsions, headache and various cerebral diseases believed to be caused by confined demons''.” Osler's theory was seen as particularly palatable by other
armchair anthropologists, who were fascinated by the idea that folk traditions and/or myths could be linked with the treatment for common conditions such as migraine. Eventually, what was nothing but speculation from Broca, quickly became a fact, and it became so in the misinterpreted version proposed by Osler as other physicians and historians kept confirming it without any actual evidence. To this day there's no credible evidence supporting this theory, especially since children are much less frequently affected by migraine and headache disorders than adults. Yet, this myth keeps existing even in modern age.
Tools and methods
As early as 7000 years ago, one of the alternative medicine practice was boring holes in the patient's neurocranium with the aim to cure and not to kill. Similar to
bloodletting
Bloodletting (or blood-letting) is the withdrawal of blood from a patient to prevent or cure illness and disease. Bloodletting, whether by a physician or by leeches, was based on an ancient system of medicine in which blood and other bodily flu ...
, trepanation was carried out for both medical reasons and mystical practice.
In ancient times, trepanation instruments were less complex, and were commonly made out of flint, obsidian, or harder material such as stone knives, and later with metal such as bronze and copper.
Additionally, the procedure was done by shamans or witch doctors utilizing ''tumi'' (ceremonial knife in early Peru), sharpened seashells (South Pacific), a trephine drill, bronze knife, etc.
The Greeks and
Romans
Roman or Romans most often refers to:
*Rome, the capital city of Italy
* Ancient Rome, Roman civilization from 8th century BC to 5th century AD
*Roman people, the people of ancient Rome
*''Epistle to the Romans'', shortened to ''Romans'', a lette ...
were the first to design medical instruments that were used to penetrate the skull.
Such instruments includes the ''terebra serrata'' made to perforate the cranium by manually rolling the instrument between the surgeon's hand.
By the Renaissance period, when trepanation was routinely performed, a range of instruments was developed to accommodate the demand.
As many as five main methods were found for trephination:
# Rectangular intersecting cuts
# Scraping utilizing an abrasive instrument such as flint
# Circular grooving
# Boring and cutting by a circular trephine or crown saw
# Burr hole done by drilling several circle holes closely to create a space and then cut/chisel the bone between the hole.
The scraping method was found to be the most common in prehistoric times.
The differences in method vary in the amount and depth of bone being removed. The trepanation surgical procedure includes exposure of the dura mater without damaging the underlying blood vessels, meninges, and brain. Over time, the skin will reform over the puncture site, but the hole in the skull will remain.
The location of the trepanation on the skull varies by geographical region and period, common locations are the
frontal
Front may refer to:
Arts, entertainment, and media Films
* ''The Front'' (1943 film), a 1943 Soviet drama film
* ''The Front'', 1976 film
Music
* The Front (band), an American rock band signed to Columbia Records and active in the 1980s and e ...
and the
occipital
The occipital bone () is a cranial dermal bone and the main bone of the occiput (back and lower part of the skull). It is trapezoidal in shape and curved on itself like a shallow dish. The occipital bone overlies the occipital lobes of the cereb ...
bones.
In most cases, trepanation was a one-off operation, with only a small percentage of the trepanned skulls having undergone more than one surgery. In those with multiple openings, the extent of bone remodelling helps identify whether the opening was done at around the same time or at different times during the individual's life.
Risks
The procedure comes with severe repercussions such as direct or indirect perioperative complications, which include increased damage to the brain, infection, blood loss, hemorrhage, and potentially death due to the trauma as the skull's protective covering is compromised. It's not a risky procedure if the trepanation is done by a
neurosurgeon
Neurosurgery or neurological surgery, known in common parlance as brain surgery, is the medical specialty concerned with the surgical treatment of disorders which affect any portion of the nervous system including the brain, spinal cord and peri ...
, but self-trepanation has many risks. The operation leaves very minimal space for error and a high incidence of mortality if the dura mater is penetrated. Additionally, there is a high risk of infection if the operation is conducted with contaminated tools or improper sanitary wound care. If the infection is not caught and treated immediately, it can be fatal or lead to significant and permanent brain damage. After surgery,
hyperemia
Hyperaemia (also hyperemia) is the increase of blood flow to different tissues in the body. It can have medical implications but is also a regulatory response, allowing change in blood supply to different tissues through vasodilation. Clinically, ...
and
osteoclast
An osteoclast () is a type of bone cell that breaks down bone tissue. This function is critical in the maintenance, repair, and remodeling of bones of the vertebral skeleton. The osteoclast disassembles and digests the composite of hydrated pro ...
ic activity are seen on the necrotic bone surrounding the trepanation site, due to loss of blood supply.
The perforations were found with the growth of fine bone spurs, which indicate that trepanation had been carried out on live subjects, rather than being a ritual conducted after death. There is evidence that some individuals survived multiple skull surgeries. There is evidence of bone remodelling around the skull defects, corroborated by the smooth borders around the opening, sealed by a dense cortex of bone, denoting procedural success after trepanation. Furthermore, the survival rate of the operations was higher than expected and the infection rate relatively low.
However, several skulls also show the risk of the operation, with some indicating the stopping mid-operation as the trephining is incomplete''.''
Voluntary trepanation
Since the early 1960s, voluntary trepanation has been performed by people interested in "enhancing mental power and well-being".
The practice of trepanning also continues today due to belief in various
pseudoscientific medical benefits. For example, some have tried trepanation as a means of emulating the "
third eye
The third eye (also called the mind's eye or inner eye) is a mystical invisible eye, usually depicted as located on the forehead, which provides perception beyond ordinary sight. In Hinduism, the third eye refers to the ajna (or brow) chakra. In ...
", in order to achieve
clairvoyance
Clairvoyance (; ) is the magical ability to gain information about an object, person, location, or physical event through extrasensory perception. Any person who is claimed to have such ability is said to be a clairvoyant () ("one who sees cl ...
or
enlightenment or even as a means of maintaining a "permanent state of
euphoria". Other proponents claim that trepanning results in increased blood flow. Individuals have practiced non-emergency trepanning for psychological purposes. A prominent proponent of the modern view is Peter Halvorson, who drilled a hole in the front of his own skull to increase "brain blood volume".
One of the most prominent advocates of trepanning was
Dutch
Dutch commonly refers to:
* Something of, from, or related to the Netherlands
* Dutch people ()
* Dutch language ()
Dutch may also refer to:
Places
* Dutch, West Virginia, a community in the United States
* Pennsylvania Dutch Country
People E ...
librarian
Bart Huges
Hugo Bart Huges (also Hughes; 23 April 1934 – 30 August 2004) was a Dutch librarian and proponent of trepanation. He attended medical school at the University of Amsterdam, but was refused a degree due to his advocacy of LSD research and naming ...
. In 1965, Huges drilled a hole in his own head with a dentist drill as a publicity stunt. Huges claimed that trepanning increases "brain blood volume" and thereby enhances cerebral metabolism in a manner similar to cerebral
vasodilators
Vasodilation is the widening of blood vessels. It results from relaxation of smooth muscle cells within the vessel walls, in particular in the large veins, large arteries, and smaller arterioles. The process is the opposite of vasoconstriction ...
such as
ginkgo biloba
''Ginkgo biloba'', commonly known as ginkgo or gingko ( ), also known as the maidenhair tree, is a species of tree native to China. It is the last living species in the order Ginkgoales, which first appeared over 290 million years ago. Fossils ...
. These claims are unsubstantiated by research. Huges and his girlfriend also made several comic books in the 1970s, which promoted trepanation.
In a chapter of his book ''Eccentric Lives & Peculiar Notions'', esotericist
John Michell
John Michell (; 25 December 1724 – 21 April 1793) was an English people, English natural philosophy, natural philosopher and clergyman who provided pioneering insights into a wide range of scientific fields including astronomy, geology, opti ...
cites Huges as pioneering the idea of trepanning in his 1962 monograph, ''Homo Sapiens Correctus'', which is often cited by advocates of self-trepanation. Among other arguments, Huges contends that children have a higher state of consciousness and since children's skulls are not fully closed, one can return to an earlier, childlike state of consciousness by self-trepanation. Further, by allowing the brain to freely pulsate Huges argues that a number of benefits will accrue.
Michell quotes
Joey Mellen's book, ''Bore Hole''. At the time the passage below was written, Joey and his partner,
Amanda Feilding
Amanda Claire Marian Charteris, Countess of Wemyss and March (; born 30 January 1943), also known as Amanda Feilding, is an English drug policy reformer, lobbyist, and research coordinator. In 1998, she founded the Foundation to Further Conscio ...
, had made two previous attempts at trepanning Mellen. The second attempt ended up placing Mellen in the hospital, where he was reprimanded severely and sent for psychiatric evaluation. After he returned home, Mellen decided to try again. He describes his third attempt at self-trepanation:
After some time there was an ominous sounding schlurp and the sound of bubbling. I drew the trepan out and the gurgling continued. It sounded like air bubbles running under the skull as they were pressed out. I looked at the trepan and there was a bit of bone in it. At last!
Feilding also performed a self-trepanation with a drill, while Mellen shot the operation for the short film "
Heartbeat in the Brain", which was long thought to have been lost. Portions of the film can be seen in the documentary ''
A Hole in the Head
''A Hole in the Head'' (1959) is a DeLuxe Color comedy film, shown in CinemaScope, directed by Frank Capra, featuring Frank Sinatra, Edward G. Robinson, Eleanor Parker, Keenan Wynn, Carolyn Jones, Thelma Ritter, Dub Taylor, Ruby Dandridge, ...
''.
Michell also describes a British group that advocates self-trepanation to allow the brain access to more space and oxygen. Other modern practitioners of trepanation claim that it holds other medical benefits, such as a treatment for depression or other psychological ailments. In 2000, two men from
Cedar City, Utah, were prosecuted for practicing medicine without a license after they performed a trepanation on an English woman to treat her chronic fatigue syndrome and
depression.
Reporters Committee for Freedom of the Press (2000) ''ABC ordered to hand over unedited head-drilling tapes''
August 23, 2016, at the Wayback Machine
The Wayback Machine is a digital archive of the World Wide Web founded by the Internet Archive, a nonprofit based in San Francisco, California. Created in 1996 and launched to the public in 2001, it allows the user to go "back in time" and see ...
.
See also
* Craniotomy
A craniotomy is a surgical operation in which a bone flap is temporarily removed from the skull to access the brain. Craniotomies are often critical operations, performed on patients who are suffering from brain lesions, such as tumors, blood clot ...
* Mütter Museum
The Mütter Museum is a medical museum located in the Center City area of Philadelphia, Pennsylvania. It contains a collection of anatomical and pathological specimens, wax models, and antique medical equipment. The museum is part of The Coll ...
* Shrunken head
A shrunken head is a severed and specially prepared human head that is used for trophy, ritual, or trade purposes.
Headhunting has occurred in many regions of the world, but the practice of headshrinking has only been documented in the northwes ...
References
External links
"Hole in the Head" – documentary on trepanation
An illustrated history of trepanation
Interview with self-trepanner Heather Perry
ABC: A History of Craniotomy
phisick.com 14 Nov 2011
{{Authority control
Webarchive template wayback links
Body modification
History of neuroscience
Neurosurgical procedures
Obsolete medical procedures
Pseudoscience