skull is rounded off by ingrowth of new bony tissue, indicating that the patient survived the operation.|218x218px exhibited at the Musée archéologique de Saint-Raphaël (Archeological Museum of
Saint-Raphaël), found in
Comps-sur-Artuby (France). The subjects survived operations. trepanning a skull, , in one of the earliest American portraits. Clarke is alleged to have been the first physician to have performed the operation in the
New England Colonies.
Prehistoric evidence Trepanation dates back to 7,000–10,000 years ago, and in some areas may have been quite widespread. Trepanation is a worldwide practice that was extremely common during the Neolithic era. The main pieces of archaeological evidence are in the forms of human remains. At one burial site in
France dated to 6500 BCE, 40 out of 120
prehistoric 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, China and
the Americas. 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 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 Mesoamerica, evidence for the practice of trepanation and an assortment of other
cranial 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 societies, trepanning is most commonly found in the
Andean civilizations, such as pre-
Incan cultures. For example, the Paracas culture
Ica, situated in what is now known as Ica, located south of Lima. The oldest skull can be found in Paracas culture (700BC - AD300). Roman cultures left behind evidence of the practice by leaving lectures and writings written by scholars. (in modern-day Colombia) and the
Inca Empire. The Inca Empire used trepanation as a treatment for epilepsy and medicine. The rate of skulls being found in Perú were significantly high. Between 11 and 40% of skulls were found throughout different parts of the area. Instruments and techniques used in Perú seemed advanced due to the number of trephined skulls that missed the midline of the skull. This suggests that these cultures tried to decrease the risks and damages of this procedure. Avoiding the midline of the skull reduced damage to the cerebral sagittal sinus. This reflects the improvement survival rate increasing over time which was 80%. 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 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 victims. Several Mesoamerican cultures used a skull-rack (known by its
Nahuatl term,
tzompantli), 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 Carl Lumholtz. Later studies documented cases identified from a range of sites in
Oaxaca and central
Mexico, such as
Tilantongo, Oaxaca and the major
Zapotec site of
Monte Albán. Two specimens from the
Tlatilco civilization's homelands (which flourished around 1400 BCE) indicate the practice has a lengthy tradition. Specimens identified from the
Maya civilization region of southern Mexico,
Guatemala and the
Yucatán Peninsula 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 in
Chiapas, and recovered from the
Sacred Cenote at the prominent Postclassic site of
Chichen Itza 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 that usually entails non-surgical treatments such as
acupuncture, balancing
Qigong,
cupping,
herbal remedies, etc. The resulting misconception was that trepanation was not practiced in ancient China. Trepanned skulls have been found since the 1940s throughout China. Some of these skulls have dated back to the 3rd and 1st century BCE. However, in 2007, Han and Chen from the Institute of Archeology,
Chinese Academy of Social Sciences 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. The hair may or may not have been shaved depending upon the site of the operation. Trepanning at the
Kisii people 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. Central Europe during the Neolithic era had an important understanding of the risks of trepanation. They used aids like rudimental anesthetic, antiseptic, and technological aids. In the graveyards of pre-Christian (
Pagan)
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. Additional research has suggested that the male to female proportion of these individuals was 2:1. Children accounted for only 7% of trephined skulls. During the 16th and 17th centuries, around 80% of people survived the procedure of trepanation. 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 and
subdural hematomas, and surgical access for certain other neurosurgical procedures, such as intracranial pressure monitoring. Modern surgeons generally use the term
craniotomy for this procedure. Unlike in folk practices, a craniotomy must be performed only after diagnostic imaging (like
computed tomography and
magnetic resonance imaging) 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 drills, 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%. In China, twelve shaman corpses in a tomb were found with trephined bodies because they also had duties of doctors. 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 intellectual disability. == Tools and methods ==