Trepanation (also known as trepanning, trephination, trephining or burr hole) is a form of surgery in which a hole is drilled or scraped into the skull, thus exposing the dura mater in order to treat health problems related to intracranial diseases, though in the modern era it is used only to treat epidural and subdural hematomas, and for surgical access for certain other neurosurgical procedures (e.g. intracranial pressure monitoring).

Trepanation has been carried out for both medical reasons and mystical practices for a long time: Evidence of trepanation has been found in prehistoric human remains from Neolithic times onwards, per cave paintings indicating that people believed the practice would cure epileptic seizures, migraines, and mental disorders. Furthermore, Hippocrates gave specific directions on the procedure from its evolution through the Greek age.

Trepanation in pre-Columbian Mesoamerica

Trepanation, which is also known as trephining, trephinning, or trepanning, refers to the surgical practice of removing a small piece of bone from the skull, generally to relieve pressure on the brain. Techniques of trephinning in pre-Columbian Mesoamerica were identical to techniques practiced in the eastern hemisphere.

Trephinning involves drilling a hole into a human skull using any of several techniques. If the operation is successful, the bone begins to grow back, beginning at the rims of the hole and growing toward the center of the hole. The new bone growth is shallower than the bone at the rim, enabling scientists to determine whether a person survived after the operation. Trephinning appears to have been a truly global phenomenon, found in populations around the world dating as far back as Neolithic times.

Prior to the conceptual revolutions within the social sciences during the mid-1960s through the early 1970s, physical anthropology studies of pre-Columbian Mesoamerican populations were chiefly concerned with identifying and classifying skeletal abnormalities and exotic features such as trephinning, dental mutilation, and artificial cranial deformation. The work was primarily descriptive, with attention drawn to variations over geography and time. Because the establishment of pre-Columbian timelines was as problematic as it was important to archaeologists and physical anthropologists, focus on simply the antiquity of a practice was often a primary goal of such studies.

As the goals of archaeology and physical anthropology changed, studies of pre-Columbian Mesoamerican osseous remains began to correlate deformation practices with other cultural behaviors. A study of lesions on seventy-two intentionally-modified crania from Cholula reflecting both sexes, all ages, and chronological phases spanning 700 years concluded that the lesions appeared to have been deliberately inflicted not for pain relief but for either ritual or preventive medical purposes. A study of ten low status burials from Late Classic Monte Alban concluded that the trephinning had been applied non-therapeutically, and, since multiple techniques had been used and since some people had received more than one trephinning, the trephinning had been done experimentally. Inferring the events to represent experiments on people until they died, the study interpreted that use of trephinning as an indicator of the stressful sociopolitical climate that not long thereafter resulted in the abandonment of Monte Alban as the primary regional administrative center.

Trepanation in literature

• Trepanation turns up in the first of Patrick O'Brian's Aubrey-Maturin series, Master and Commander, set during the Napoleonic Wars. The gunner on the Sophie, Jack Aubrey's first command, is injured during an engagement with an "Algerine." Stephen Maturin has recently come on as the ship's physician:

"This is a depressed cranial fracture, sir, and I must use the trephine: here he lies—you notice the characteristic stertor?—and I think he is safe until the morning. But as soon as the sun is up I must have off the top of his skull with my little saw. You will see the gunner's brain, my dear sir," he added with a smile. "Or at least his dura mater."

"Oh dear, oh dear," murmured Jack. Deep depression was settling on him—anticlimax—such a bloody engagement for so little—two good men killed—the gunner almost certainly dead—no man could survive having his brain opened, that stood to reason.

In fact the gunner survives and thrives and his shipmates tell the story far and wide, making Stephen a legend in the Royal Navy.

• The trilogy His Dark Materials (consisting of the novels Northern Lights, The Subtle Knife, and The Amber Spyglass) by Philip Pullman makes several references to trepanation by the Tartars, notably in the second chapter ("The Idea of North") of the first novel in the trilogy:

Lord Asriel said, "I found his Grumman's body preserved in the ice off Svalbard. The head was treated this way by his killers. You'll notice the characteristic scalping pattern. I think you might be familiar with it, Sub-Rector."

The old man's voice was steady as he said, "I have seen the Tartars do this. It's a technique you find among the aboriginals of Siberia and the Tungusk. From there, of course, it spread to the lands of the Skraelings, though I understand that it is now banned in New Denmark. May I examine it more closely, Lord Asriel?"

After a short silence he spoke again.

"My eyes are not very clear, and the ice is dirty, but it seems to me that there is a hole in the top of the skull. Am I right?"

"You are."

"Trepanning?"

"Exactly."

• In the Japanese manga Homunculus by Hideo Yamamoto, the main character undergoes a trepanation. This character, Susumu Nakoshi, is a middle-aged man who lives in his car, between a hotel and a public park where lots of homeless people gather. One day, a youngster dressed in a extreme way, approaches Susumu and asks him whether he is interested in participating in a trepanation experiment or not, which is very well paid. The young man is, in fact, a Medicine student who wants to know more about humans, and he wishes to confirm if trepanation can grant people a sixth sense, such as seeing dead people or psychic powers. Susumu himself, despite his initial and logical objections, is forced to give in when he's in a need of money. And he sure will prove to be a great piece of evidence on this fact.

• In The Third Eye, a book published in the United Kingdom in 1956, the author Lobsang Rampa describes an operation similar to trepanation which allegedly gave him the power of clairvoyance. However, the book led to controversy when it was discovered that the author was not a monk from Tibet as claimed, but a man named Cyril Henry Hoskins who had been born in Devon in the UK.

• The band Disposable Thumbs wrote a song about trepanation entitled "Grey Is The Matter".

• In 120 Days of Sodom by the Marquis de Sade, in the fourth part, a man who enjoys killing people by means of a torture that involves trepanning is discussed:

In the space of a single day, he performs four operations upon the young man: a gallstone removal, a trepanning, the excision of a fistula in the eye, of one in the anus. He knows just enough about surgery to botch all four operations; then he abandons the patient, giving him no further help and watching him expire.

• In the His Dark Materials trilogy by Philip Pullman, the Tartars (a warlike people who live in the north) are known to perform Trepanning to let in more Dust.

See also

• Mütter Museum

External links

• WHO surgical instructions on burr holes
• Skeptic's Dictionary entry about Trepanation
• International Trepanation Advocacy Group
• Diary of a trepannee, circa 2000
• A humorous essay that deals with Trepanation
• Morbid Fixation on Trepanning

History of neuroscience | Neurology | Neurosurgery | Surgery | Quackery

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