Trephination: A Look at Early Skull Surgery

Trephination, also known as trepanation, is one of the oldest surgical procedures in human history. It involves creating a hole in the skull to treat medical conditions like head injuries, pressure in the brain, or even mental illness. This procedure was performed thousands of years ago using simple tools made of stone or metal, and surprisingly, many patients survived, as shown by skulls with signs of healing.

The process began with the patient being restrained, either held down or supported by a brace to keep the head still. In some cases, natural sedatives like alcohol or plant-based substances may have been used to reduce pain or anxiety. Once the patient was secured, the surgeon would cut through the scalp, often in a cross shape, to expose the skull.

Next, the surgeon used a scraping tool or a basic hand drill to slowly wear away the bone. This part of the operation could take hours. In some cultures, a bow-like tool was used to rotate the metal drill back and forth. The goal was to remove a circular piece of bone without going too deep and damaging the protective membrane covering the brain, called the dura mater.

Once the bone was removed, the surgeon would clean the area, possibly with herbal substances to reduce the risk of infection. In many cases, the wound was left open to allow harmful fluids or so-called evil spirits to escape. The operation required great care because if the dura mater was punctured, the patient was likely to die. Still, archaeological evidence suggests that many people healed and lived for years afterwards.

In modern medicine, a similar operation is called a craniotomy. Surgeons today use advanced imaging to locate the problem before the surgery begins. After cutting through the scalp, they use electric tools to remove part of the skull. The dura is carefully protected throughout the operation. Once the issue is treated, the bone is replaced and secured with plates or screws, and the wound is closed in a sterile environment.

While trephination was done with limited tools and no understanding of germs or anaesthesia, it laid the foundation for today’s brain surgeries. The concept of relieving pressure or treating injuries by accessing the skull has remained the same, showing how early human innovation still influences modern medical practices.

Written by Ariela Okonta at Incisionary

APA References

Cohut, M. (2019, September 6). Trepanation: Our ancestors’ idea of neurosurgery. Www.medicalnewstoday.com. https://www.medicalnewstoday.com/articles/326281

González-Darder, J. M. (2017). Cranial trepanation in primitive cultures. Neurocirugía (English Edition), 28(1), 28–40. https://doi.org/10.1016/j.neucie.2016.04.001

Gross, C. (2019, August 29). A Hole in the Head: A Complete History of Trepanation. The MIT Press Reader. https://thereader.mitpress.mit.edu/hole-in-the-head-trepanation/

Irving, J. (2013, May 1). Trephination. World History Encyclopedia. https://www.worldhistory.org/Trephination/

Kimball, J. (2024, March 14). Brown Ph.D. student uncovers early evidence of brain surgery in Ancient Near East. Brown University. https://www.brown.edu/news/2023-02-22/megiddo

McIntire, T. (2022, October 27). A Hole in the Head--Civil War Trephination. National Museum of Civil War Medicine. https://www.civilwarmed.org/a-trephination/