Imaging Evaluation of Skull Trepanation Using Radiography and CT

Cranial surgery as practised by the prehistoric and present-day traditional medicine man is the oldest known and one of the highest surgical achievements in the history of medicine. This study examines morbidity and mortality of this ancient surgical procedure by re-examining and reviewing reports of 71 completely trepanned skulls from pre-Columbian Peru by three techniques: gross visual observation and palpation; radiography; and CT. The specimens are located in the San Diego Museum of Man and are part of the Hrdlicka collection. Clear distinction can be made by visual observation between skulls with bone regeneration and those without; that is, between patients who survived long enough to allow bone healing and those who died immediately or within a few days of the operation. 64.8 per cent of skulls had complete healing, 12.7 per cent had partial healing and 22.5 per cent had no evidence of healing. Thus, a post-operative survival rate of 77.5 per cent is noted by gross examination. The meaning of completely trepanned skulls with no evidence of healing is questionable, however, some unhealed skulls may represent post-mortem trepanation, suggesting a lower surgical mortality. Both radiography and CT scan demonstrate with considerable accuracy the presence or absence of new bone formation on trepanned skulls. One skull demonstrated evidence of partial bone healing by CT and radiography but not by our gross examination or by that of some anthropologists. Evidence of osteomyelitis was illustrated by CT scan but not by radiography.     

Trepanations from Oman: A case of diffusion?

Trepanations have been described from various locations around the world leading to a suggestion that this is a cultural practice that has widely diffused from one or two centres ( 1 ). In the UAE the earliest trepanations date to the Neolithic, significantly earlier than trepanations in surrounding areas. The discovery of at least two crania in Oman, dating apparently to the early third millennium and resembling in technique and placement trepanations from north India may be evidence of the diffusion of a therapeutic practice from the Gulf to the subcontinent. However, the lack of any trepanation among the numerous contemporary skeletons from Bahrain suggests that any diffusion has distinct limits and that, as anthropological work from the South Pacific ( 2 ) indicates, practices like trepanation are often heavily embedded in broader, culturally located explanatory models.     

The Ciempozuelos Necropolis skull: a case of double trepanation?

The focus of this study is the analysis of a trepanation performed on the skull of an adult male from the famous Bell Beaker necropolis of Ciempozuelos (Madrid) excavated at the end of the 19^th century. The unusual characteristics of the pottery and other associated grave goods gave rise to the use of the name ‘Ciempozuelos’ to define the regional Bell Beaker style; this refers to similar finds from other sites on the Meseta of central Spain. Although trepanations from Chalcolithic contexts in the Iberian peninsula are not infrequent, they are unusual in Bell Beaker inhumations. Furthermore, this skull is exceptional not only for the type of trepanation performed, but also for the subsequent cranial deformation apparently resulting from the operation, as well as evidence of a second subsequent trepanation which indicates a very short post‐surgical survival period for the individual. Copyright © 2003 John Wiley & Sons, Ltd.     

Multifocal eosinophilic granuloma with a possible trepanation in a fourteenth century Greek young skeleton

Multiple lytic lesions in the cranial remains of a young adolescent from medieval Corinth in Greece, display characteristics best associated with multifocal eosinophilic granuloma. Some of the lesions have marginal sclerosis indicative of healing. The lesions vary in size from less than one centimeter in diameter to over two centimeters. The larger lesions, in particular, appear to be the result of confluence between two or more lytic foci. These lesions, rarely described in archaeological skeletal material, result from a pathological disturbance within the reticuloendothelial system. One of the cranial lesions has a different appearance from the other lesions and may have been produced by a therapeutic trepanation. © 1997 John Wiley & Sons, Ltd.     

Two medieval ‘trepanations’ – therapy or swindle?

During the 1991–1992 excavation of the ruins of the medieval cathedral in Hamar, Norway, the broken skull of an elderly man was found, showing evidence of an incomplete trepanation. The ‘surgeon’ had obviously tried to penetrate the skull surface around bregma in an irregular circle of 23 × 21 mm. Upon investigation, the skull revealed a reactive‐pathological area of the internal surface of the occipital bone, which probably represents a respite after a meningeal disorder (a tumour or an infectious process), causing us to suggest that the trepanation was meant to cure the patient's increasing headache. However, as a second skull with similar marks was found in the same churchyard, another explanation seems possible. Because the brain tumour in the first case may have altered the patient's mental state, we may surmise that these incomplete operations were an attempt to remove from these patients' heads the ‘Stone of Madness’, which was then commonly considered to be the reason for psychiatric diagnoses as well as persistent headache, and often depicted in European art, most notably in the 16^th and 17^th centuries. The second skull, revealing an even more incomplete attempt, did not show any skeletal pathology at all. Copyright © 2007 John Wiley & Sons, Ltd.