Cranial trepanation, also called trephination, is the name given for the ancient surgical procedure to create an opening or drill holes in the skull. It represents one of the most ancient types of neurosurgery and neuroscience.
Trepanation was used in ancient times for various purposes, including:
- Treatment of head injuries, including wounds and fractures
- Healing symptoms of diseases, such as epilepsy and headaches
- Ritual reasons
- Spiritual reasons
- Letting out evil spirits in people who were thought to believe abnormally (mental disorders)
- Increasing the blood flow and preventing the development of degenerative diseases, such as Alzheimer’s
Is trepanation still used today?
Trepanation is not used in neurosurgery for medical purposes now. However, another procedure, called a craniotomy, is done that involves temporarily creating a hole in the skull to remove fluids or release pressure, and then closing the hole after a definite period.
- Craniotomy does not involve making random holes in the skull.
- Rather, it uses a specialized surgical tool to remove a particular bone section called bone flap under aseptic conditions.
A craniotomy is used to treat medical conditions, especially epidural and subdural hematomas, in which the blood collects between the coverings of the brain (meninges). The procedure is known to monitor the pressure in the skull.
The procedure helps relieve pressure beneath the skull bone. The pressure may be due to the buildup of fluid, such as pus, blood, or even air. Trepanation of the frontal sinus is a medical procedure to create a small opening in the floor of the frontal sinus. It helps release the pressure inside the sinus, clearing the pus, and completely clearing the infections.
Trepanation of the nail may be done. The procedure involves creating a hole in the fingernail or toenail to remove trapped blood under the nail. The procedure is employed in corneal transplant surgery as well.
Can you survive trepanation?
Trepanation was a typically well-tolerated procedure dating back from the Neolithic Era (10,000 to 4,500 B.C.E. or before the common era) to Late Antiquity (late third century to the seventh century) with good survival rates. However, then the survival rates seemed to have decreased until pre-modern times (late 15th and early 16th centuries), based on trepanned skulls found from each era.
There have been differences in the survival rates around the world, for example:
- The Late Iron Age Switzerland that spanned from 450 to 15 BC witnessed 78 percent survival rates. This indicates that the ancient surgical procedure was often performed successfully.
- Contrarily, only 25 percent of the trepanations from Iron Age Britain were found to heal successfully.
- The number of people surviving the surgery then improved after the Middle Ages (500 to 1500).
Nonetheless, better and safer surgical procedures have replaced trepanation in the modern era.
What’s the difference between craniotomy and trepanation?
A craniotomy is the evolved procedure of trepanation in which a part (or a bone) of the skull is removed to operate any tumor or relieve pressure in the skull or brain.
Unlike the ancestors who performed trepanation based only on experiences and modern era assumptions, craniotomy is done only after analyzing magnetic resonance imaging and computed tomography scans of the brain.
The difference between trepanation and craniotomy is that the removed piece of the skull is typically replaced as soon as possible after abnormal structures (such as tumors) have been removed. Trepanation instruments have been replaced with machines, such as drills, for craniotomy.
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Moghaddam N, Mailler-Burch S, Kara L, et al. Survival after trepanation-Early cranial surgery from Late Iron Age Switzerland. Int J Paleopathol. 2015 Dec;11:56-65. https://pubmed.ncbi.nlm.nih.gov/28802968
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