Hole(s) in the Head: A Discussion of Trephanation

Figure 1: The Chios Skull (Tsermoulas et al. 2014)

We typically characterize early humans as being simple, primitive, and less than intelligent creatures who were concerned with just surviving, but as we learn more and more about our human ancestors we begin to realize that they were creative, resourceful, and incredibly gifted.  From creating some of the world's earliest artworks to skillfully manipulating the dead and everything in between we, as humans, have been complex for several millennia.  Today's blog post will further demonstrate our ingenuity by discussing a long standing medical procedure that has been practiced since at least the Neolithic Period and continues on today: trephanation.

Trephination, also referred to as trepanation, is a surgical procedure that involves the removal of part of the skull through drilling, cutting, boring, or scraping, leading to the exposure of the brain, meninges, and blood vessels without damaging them (Figure 1).  This remains one of the earliest neurosurgical methods practiced, dating back to 10,000 years ago in both Europe and South America.  It was practiced widely throughout the world, with evidence being found among groups in the Middle East, Asia, and Central America, as well. 

Trephination was practiced for two primary purposes: medical or supernatural.  Medical practitioners and religious officiants would perform this procedure either to relieve an individual of pain related to cranial trauma, migraines, headaches, or other identified medical ailment or to rid an individual of demonic possession or attack if the person was exhibiting symptoms related to such matters (e.g. seizures, mental illness, etc.)  Pieces of the skull would be carefully removed during the procedure, which was practiced on adults and children regardless of sex.  This procedure was so precisely done that most individuals survived (as evidenced by healing at the incision site) and often underwent additional procedures. 

Archaeological and bioarchaeological evidence has informed scholars and modern medical doctors of the practice.  Evidence of its practice has been found on cave paintings, ceramic vessels, as well as imprinted on the bodies themselves.  The ancient Greek scholar Hippocrates chronicled the practice in his medical texts.  Because of the prolific practice of this surgical technique and its success in assisting people in surviving traumatic injuries this practice continues today, although in strictly medical capacities for the most part (although there is evidence of some individuals practicing self-trepanning for mystical purposes).  The carrying on of this practice over the centuries may have led to a refinement of the technique.  Furthermore, trephanation demonstrates the importance of not doubting the ability of any human beings, particularly those we often overlook as less capable.  Our human ancestors overcame a great deal of challenges in spite of limited options available to them, and we continue to face and beat the odds even today.     

References

Chew, L. (2000). Trephination. Retrieved from http://home.wlu.edu/~lubint/touchstone/2000/Trephination-Chew.htm

Irving, J. (2013, May 01). Trephination. Ancient History Encyclopedia. Retrieved from https://www.ancient.eu/Trephination/

 

Moghaddam, N., Mailler-Burch, S., Kara, L., Kanz, F., Jackowski, C., & Losch, S. (2015). Survival after trepanation—Early cranial surgery from Late Iron Age Switzerland. International Journal of Paleopathology, 56-65.

Tsermoulas G, Aidonis A, Flint G.  2014.  The skull of Chios: trepanation in Hippocratic medicine.  J Neurosurg 121(2):328-32