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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 (, , ; ) was the language spoken in most of the northern half of France approximately between the late 8th -4; we might wonder whether there's a point at which it's appropriate to talk of the beginnings of French, that is, when it wa ...

from Medieval Latin from Ancient Greek">Greek Greek may refer to: 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 of all kno ...

, literally "borer, auger"), is a surgical intervention in which a hole is drilled or scraped into the human skull. The intentional perforation of the cranium exposes the ''dura mater'' 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 τρύπανον, ''trypanon'' '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 spe ...

is an instrument used for cutting out a round piece of skull bone to relieve pressure beneath a surface. Trepanning was sometimes performed on people who were behaving in a manner that was considered abnormal. In some ancient societies it was believed this released the evil spirits that were to blame. Evidence of trepanation has been found in prehistoric human remains from

Neolithic The Neolithic or New Stone Age (from Ancient Greek, Greek 'new' and 'stone') is an archaeological period, the final division of the Stone Age in Mesopotamia, Asia, Europe and Africa (c. 10,000 BCE to c. 2,000 BCE). It saw the Neolithic Revo ...

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 (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 (: stomata, from Greek language, Greek ''στόμα'', "mouth"), also called a stomate (: stomates), is a pore found in the Epidermis (botany), epidermis of leaves, stems, and other organs, that controls the rate of gas exc ...

. 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

Trepanated skull of a woman-P4140363-black

Prehistoric evidence

Trepanation dates back to 7,000–10,000 years ago, is perhaps the oldest surgical procedure for which there is

archaeological Archaeology or archeology is the study of human activity through the recovery and analysis of material culture. The archaeological record consists of Artifact (archaeology), artifacts, architecture, biofact (archaeology), biofacts or ecofacts, ...

evidence, and in some areas may have been quite widespread. The main pieces of archaeological evidence are in the forms of human remains. At one burial site in

France France, officially the French Republic, is a country located primarily in Western Europe. Overseas France, Its overseas regions and territories include French Guiana in South America, Saint Pierre and Miquelon in the Atlantic Ocean#North Atlan ...

dated to 6500 BCE, 40 out of 120

prehistoric Prehistory, also called pre-literary history, is the period of human history between the first known use of stone tools by hominins million years ago and the beginning of recorded history with the invention of writing systems. The use o ...

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 5–10% of all cranial remains from that era) have been uncovered throughout the worldfrom Europe,

Siberia Siberia ( ; , ) is an extensive geographical region comprising all of North Asia, from the Ural Mountains in the west to the Pacific Ocean in the east. It has formed a part of the sovereign territory of Russia and its predecessor states ...

, China and

the Americas The Americas, sometimes collectively called America, are a landmass comprising the totality of North America and South America.'' Webster's New World College Dictionary'', 2010 by Wiley Publishing, Inc., Cleveland, Ohio. When viewed as a sin ...

. 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 subject research, human participants designed to answer specific questions about biomedical or behavioral interventions, including new treatments (such as novel v ...

or for other unknown reasons. However, it could be the earliest archaeological example of veterinary surgery or animal medical experimentation.

Pre-Columbian Mesoamerica

In the more recent times of postclassical

pre-Columbian In the history of the Americas, the pre-Columbian era, also known as the pre-contact era, or as the pre-Cabraline era specifically in Brazil, spans from the initial peopling of the Americas in the Upper Paleolithic to the onset of European col ...

Mesoamerica Mesoamerica is a historical region and cultural area that begins in the southern part of North America and extends to the Pacific coast of Central America, thus comprising the lands of central and southern Mexico, all of Belize, Guatemala, El S ...

, evidence for the practice of trepanation and an assortment of other

cranial Standard anatomical terms of location are used to describe unambiguously the anatomy of humans and other animals. The terms, typically derived from Latin or Greek language, Greek roots, describe something in its standard anatomical position. Thi ...

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 used to describe the majority of lands of Earth's Western Hemisphere, particularly the Americas, and sometimes Oceania."America." ''The Oxford Companion to the English Language'' (). McArthur, Tom, ed., 1992. New York: ...

societies, trepanning is most commonly found in the

Andean The Andes ( ), Andes Mountains or Andean Mountain Range (; ) are the longest continental mountain range in the world, forming a continuous highland along the western edge of South America. The range is long and wide (widest between 18°S ...

civilizations, such as pre-

Incan The Inca Empire, officially known as the Realm of the Four Parts (, ), was the largest empire in pre-Columbian America. The administrative, political, and military center of the empire was in the city of Cusco. The Inca civilisation rose fr ...

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 The Muisca Confederation was a loose confederation of different Muisca rulers (''zaques'', ''zipas'', ''iraca'', and ''tundama'') in the central Andes, Andean highlands of what is today Colombia before the Spanish conquest of the Americas, Spanis ...

(in modern-day Colombia) and the

Inca Empire The Inca Empire, officially known as the Realm of the Four Parts (, ), was the largest empire in pre-Columbian America. The administrative, political, and military center of the empire was in the city of Cusco. The History of the Incas, Inca ...

. In both, even cranioplasty 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 an act or offering made to a deity. A sacrifice can serve as propitiation, or a sacrifice can be an Offering (Christianity), offering of praise and thanksgiving. Evidence of ritual animal sacrifice has been seen at least since an ...

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 Nahuas, most of whom live mainly in Central Mexico and have smaller popul ...

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 human trophy taking in Mesoamerica, war captives or other huma ...

''), 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 is a branch of anthropology and the systematic study of individual cultures. It explores cultural phenomena from the point of view of the subject of the study. Ethnography is also a type of social research that involves examining ...

Carl Lumholtz. Later studies documented cases identified from a range of sites in

Oaxaca Oaxaca, officially the Free and Sovereign State of Oaxaca, is one of the 32 states that compose the political divisions of Mexico, Federative Entities of the Mexico, United Mexican States. It is divided into municipalities of Oaxaca, 570 munici ...

and central

Mexico Mexico, officially the United Mexican States, is a country in North America. It is the northernmost country in Latin America, and borders the United States to the north, and Guatemala and Belize to the southeast; while having maritime boundar ...

, 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 near the modern town of Santiago Tilantongo. It is located at 17°15' N. Lat. and 97°17' W. Long. Its ...

, 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 Mexico, Mexican state of Oaxaca (17.043° N, 96.767°W). The site is located on a low mountainous range rising above the plain i ...

. 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. Specimens identified from the

Maya civilization The Maya civilization () was a Mesoamerican civilization that existed from antiquity to the early modern period. It is known by its ancient temples and glyphs (script). The Maya script is the most sophisticated and highly developed writin ...

region of southern Mexico,

Guatemala Guatemala, officially the Republic of Guatemala, is a country in Central America. It is bordered to the north and west by Mexico, to the northeast by Belize, to the east by Honduras, and to the southeast by El Salvador. It is hydrologically b ...

and the

Yucatán Peninsula The Yucatán Peninsula ( , ; ) is a large peninsula in southeast Mexico and adjacent portions of Belize and Guatemala. The peninsula extends towards the northeast, separating the Gulf of Mexico to the north and west of the peninsula from the C ...

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: ), also anciently known in the Itza Language as Lakamha ("big water" or "big waters"), was a Maya city-state in southern Mexico that perished in the 8th century. The Palenque ruins date from ca. 226 BC to ca. 799 AD ...

Chiapas Chiapas, officially the Free and Sovereign State of Chiapas, is one of the states that make up the Political divisions of Mexico, 32 federal entities of Mexico. It comprises Municipalities of Chiapas, 124 municipalities and its capital and large ...

, and recovered from the Sacred Cenote at the prominent Postclassic site of

Chichen Itza Chichén Itzá , , often with the emphasis reversed in English to ; from () "at the mouth of the well of the Itza people, Itza people" (often spelled ''Chichen Itza'' in English and traditional Yucatec Maya) was a large Pre-Columbian era, ...

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 medicine, alternative medical practice drawn from traditional medicine in China. A large share of its claims are pseudoscientific, with the majority of treatments having no robust evidence ...

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 ()) is a system of coordinated body-posture and movement, breathing, and meditation said to be useful for the purposes of health, spirituality, and martial arts training. With roots in Traditional Chinese Medicine, Chinese medicine, Chin ...

, cupping,

herbal remedies Herbal medicine (also called herbalism, phytomedicine or phytotherapy) is the study of pharmacognosy and the use of medicinal plants, which are a basis of traditional medicine. Scientific evidence for the effectiveness of many herbal treatments ...

, 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 state research institute and think tank. It is a ministry-level institution under the State Council of the People's Republic of China. The CASS is the highest academic institution and c ...

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 Organ (biology), organs have been preserved by either intentional or accidental exposure to Chemical substance, chemicals, extreme cold, very low humidity, or lack of air, so that the ...

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,

Shandong Shandong is a coastal Provinces of China, province in East China. Shandong has played a major role in Chinese history since the beginning of Chinese civilization along the lower reaches of the Yellow River. It has served as a pivotal cultural ...

. The skull, which belonged to an adult male, exhibited a right parietal calvarial defect (31 x 25 mm) with evidence of scraping by a

-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. 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, also known as Eastern Africa or the East of Africa, is a region at the eastern edge of the Africa, African continent, distinguished by its unique geographical, historical, and cultural landscape. Defined in varying scopes, the regi ...

. Bones of depressed fractures were elevated by surgeons of Bunyoro-Kitara. 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 Bantu people, Bantu ethnic group indigenous to Kisii County, Kisii and Nyamira County, Nyamira counties of former Nyanza Province, Nyanza, as well as ...

in Kenya was filmed in 1958.

Pre-modern Europe

Trepanation was known to prehistoric Europeans, with some populations having impressive success rates of 78% in the Iron Age. Trepanation was also practised in the classical and

Renaissance The Renaissance ( , ) is a Periodization, period of history and a European cultural movement covering the 15th and 16th centuries. It marked the transition from the Middle Ages to modernity and was characterized by an effort to revive and sur ...

periods.

Hippocrates Hippocrates of Kos (; ; ), also known as Hippocrates II, was a Greek physician and philosopher of the Classical Greece, classical period who is considered one of the most outstanding figures in the history of medicine. He is traditionally referr ...

gave specific directions on the procedure from its evolution through the Greek age, and

Galen Aelius Galenus or Claudius Galenus (; September 129 – AD), often Anglicization, anglicized as Galen () or Galen of Pergamon, was a Ancient Rome, Roman and Greeks, Greek physician, surgeon, and Philosophy, philosopher. Considered to be one o ...

also elaborates on the procedure. During the

Middle Ages In the history of Europe, the Middle Ages or medieval period lasted approximately from the 5th to the late 15th centuries, similarly to the post-classical period of global history. It began with the fall of the Western Roman Empire and ...

and the

, 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 lies between the Baltic Sea and the North Sea to the north and the Alps to the south. Its sixteen States of Germany, constituent states have a total popu ...

, 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 (, 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 Christianity, Judaism, and Samaritanism. In the time of the ...

)

Magyars Hungarians, also known as Magyars, are an ethnic group native to Hungary (), who share a common culture, language and history. They also have a notable presence in former parts of the Kingdom of Hungary. The Hungarian language belongs to the ...

, 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

' conversion to Christianity. A small area near (modern)

Rostov-on-Don Rostov-on-Don 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 European Plain on the Don River, from the Sea of Azov, directly north of t ...

, 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 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 discredited form of Neurosurgery, neurosurgical treatment for mental disorder, psychiatric disorder or neurological disorder (e.g. epilepsy, Depression in childhood and adolescence, depression) that involves sev ...

, was performed by cutting a

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 ...

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 surrou ...

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 surgery, surgical operation in which a bone flap is temporarily removed from the Human skull, skull to access the Human brain, brain. Craniotomies are often critical operations, performed on patients who are suffering from brain ...

'' for this procedure. Unlike in folk practices, a craniotomy must be performed only after diagnostic imaging (like

computed tomography A computed tomography scan (CT scan), formerly called computed axial tomography scan (CAT scan), is a medical imaging technique used to obtain detailed internal images of the body. The personnel that perform CT scans are called radiographers or ...

and

magnetic resonance imaging Magnetic resonance imaging (MRI) is a medical imaging technique used in radiology to generate pictures of the anatomy and the physiological processes inside the body. MRI scanners use strong magnetic fields, magnetic field gradients, and ...

) has pinpointed the issue within the skull; preoperative imaging allows for accurate examination and evaluation. Unlike in trepanation, the removed piece of skull (called a bone flap) is typically replaced as soon as possible, where it can heal. 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 drill ...

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 documented cases of trepanning done in Africa and Oceania during the 20th century, patient survival rate was seen to be approximately 90%.

Myth of trepanation as a treatment for headaches

After the retrieval of some skulls from the

era that showed signs of trepanation, in the nineteenth century, the false belief that these holes were drilled for the treatment of headaches or other 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 dating to 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 emerged around 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 (medicine), residency program for speci ...

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, Broca's speculation came to be accepted as fact, and the myth was perpetuated by other historians and physicians. 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. Nevertheless, the myth persists.

Cultural perspectives on trepanation

The motivations behind trepanation varied significantly across cultures, often tied to beliefs about health, spirituality, and the treatment of ailments. Early instances of the practice may have been influenced by a combination of supernatural beliefs and early understandings of physical ailments, leading to its acceptance in various medical traditions. In many cultures, it was believed that drilling a hole in the skull will let out the evil spirits that caused pain and illness. It can be explained as most head injuries and diseases, such as migraine, felt like pounding, so cutting a hole in head may help to relieve the pain and pressure. In Africa and Europe, not only this procedure was performed for spiritual reasons, but also the discs made of cranial bones were commonly used as shield from demons and evils. In China, twelve shaman corpses in a tomb were found with trephined bodies because they also had duties of doctors. This tells about connection of cranial surgery to religion; there was conception that open hole in head contributes to communication with god and souls of dead people. Trepanation was also associated in Chinese medicine with the balance of vital energy, or qi. They understand trepanation as a way to balance the body and energy, spiritual and physical health. On the other hand, it was thought that cerebral disorder arise from the loss of spiritual image in ancient Peru, illness developed after being separated from body. Trepanation would have been done in order to allow the spirit to reenter the body. In these cases, the patient may have suffered from paralysis, cerebral palsy, severe depression, or mental retardation.

Tools and methods

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 practitioners utilizing '' tumi'' (ceremonial knife in early Peru), sharpened seashells (South Pacific), a trephine drill, bronze knife, etc. The Greeks and Romans were the first to design medical instruments to penetrate the skull. Such instruments includes the ''terebra serrata'', made to perforate the cranium by positioning the instrument's pointed end against the cranium and manually rolling the instrument's shaft back and forth between the surgeon's two hands. By the Renaissance period, when trepanation was routinely performed, a range of instruments were 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 In anatomy, the meninges (; meninx ; ) are the three membranes that envelop the brain and spinal cord. In mammals, the meninges are the dura mater, the arachnoid mater, and the pia mater. Cerebrospinal fluid is located in the subarachnoid spac ...

, 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 and the occipital 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

neurosurgeon Neurosurgery or neurological surgery, known in common parlance as brain surgery, is the medical specialty that focuses on the surgical treatment or rehabilitation of disorders which affect any portion of the nervous system including the brain, ...

can perform the procedure safely, although it 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. 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, neither the surrounding bone nor the trepanned bone piece ever show any osseous healing like other bones. Osteoclastic and osteoblastic activity occurs after the first week; hyperemia and

osteoclast An osteoclast () is a type of bone cell that breaks down bone tissue. This function is critical in the maintenance, repair, and bone remodeling, remodeling of bones of the vertebrate, vertebral skeleton. The osteoclast disassembles and digests th ...

ic activity are seen on the necrotic bone surrounding the trepanation site, due to loss of blood supply.

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 Pseudoscience consists of statements, beliefs, or practices that claim to be both scientific and factual but are incompatible with the scientific method. Pseudoscience is often characterized by contradictory, exaggerated or unfalsifiable cl ...

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 an invisible eye, usually depicted as located on the forehead, supposed to provide perception beyond ordinary sight. In Hinduism, the third eye refers to the ajna (or brow) chakra. In bot ...

", in order to achieve

clairvoyance Clairvoyance (; ) is the claimed ability to acquire information that would be considered impossible to get through scientifically proven sensations, thus classified as extrasensory perception, or "sixth sense". Any person who is claimed to h ...

or as a means of maintaining a "permanent state of

euphoria Euphoria ( ) is the experience (or affect) of pleasure or excitement and intense feelings of well-being and happiness. Certain natural rewards and social activities, such as aerobic exercise, laughter, listening to or making music and da ...

". 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 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 marijuana use. In 1964 ...

. 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

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such as

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. 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 natural philosopher and clergyman who provided pioneering insights into a wide range of scientific fields including astronomy, geology, optics, and gravitation. Considered "on ...

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 (née Feilding; 30 January 1943 – 22 May 2025) was an English drug policy reformer, lobbyist, and research coordinator. In 1998, she founded the Foundation to Further Consciousnes ...

, 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'' is a 1959 DeLuxe Color CinemaScope American comedy film directed by Frank Capra and starring Frank Sinatra, Edward G. Robinson, Eleanor Parker, Keenan Wynn, Carolyn Jones and Thelma Ritter and released by United Artists.' ...

''. 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 relief from depression and from other psychological ailments. In 2000, two men from

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, were prosecuted for practicing medicine without a license after they performed a trepanation on an English woman to treat her

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and depression. In 2023, Michael Raduga, a Russian lucid dreaming researcher, performed self-neurosurgery that included trepanation, electrode implantation, and electrical stimulation of the motor cortex. The goal was to stimulate the brain during REM sleep, sleep paralysis, and lucid dreams.

Modern interpretation and research

Modern forensic and medical research on trepanned skulls demonstrates advanced surgical skills in prehistoric societies and highlights how trepanation influenced later developments in neurosurgery and the history of medicine. With the advancement of technology, it became possible to examine and interpret the trepanned skull with CT scans and new techniques of bioarchaeology. A recent study provided new perspective of the healing process of skull after cranial trepanation: even though there are many examples of prehistoric cranial lesions that have been classified as "healed trepanations", the research shows that definition of “healing” is not consistent. One of the reasons of distinction in variations of healing process is difference of surgical methods such as “scraping” or “grooving” that might alter the angle of the edge. The first smoothening of bone begins in 5 months, but total healing or closure never happens. By the 20th century, the ancient practice of trepanning evolved into procedure of bone marrow biopsy, which became vital for identifying illnesses including anemia, leukomia, lymphoma, and tuberculosis. This change happened as doctors realized the need of accessing the inside of bones for diagnostic purposes, especially in the treatment of blood-related ailments. The initial tools of trepanation as crown trephine transitioned into the biopsy needles in modern medicine such as Vim-Silverman needle and Jamshidi needle. The instrument created a small hole in the skull, reducing the possibility of significant injury. These instruments’ adaptation in performing multiple medical functions, ranging from diagnosing blood and relieving cranial pressure, shows how tools adapt to advancements in medicine.

References

External links

WHO surgical instructions on burr holes

An illustrated history of trepanation

Interview with self-trepanner Heather Perry
* phisick.com 14 Nov 2011 {{Authority control Body modification History of neuroscience Neurosurgical procedures