The Oldest Form of Neurosurgery

Trepanation, or trephination (both derived from the Greek word trypanon, meaning “to bore”) is perhaps the oldest form of neurosurgery. The procedure, which is called a craniotomy in medical terminology, involves the removal of a piece of bone from the skull, and it has been performed since prehistoric times.

The oldest trepanned skull, found at a neolithic burial site of Ensisheim in France, is more than 7,000 years old, and trepanation was practised by the Ancient Egyptians, Chinese, Indians, Romans, Greeks and the early Mesoamerican civilizations. The procedure is still performed today, for both medical and non-medical reasons.

The trepanned skulls found at prehistoric European sites contained round holes, which varied in size from just a few centimetres in diameter to nearly half of the skull. They are most commonly found in the parietal bone, and also in the occipital and frontal bones, but rarely in the temporal bone.

In the earliest European trepanned skulls, the holes were made by scraping the bone away with sharp stones such as flint or obsidian; later, primitive drilling tools were used to drill small holes arranged in circles, after which the piece of bone inside the circle was removed. The late Medieval period saw the introduction of mechanical drilling and sawing instruments, whose sophistication would continue to increase for several hundred years.

Today, trepanning is still used routinely by doctors to treat traumatic brain injuries. The biggest advocate of trepanation for non-medical purposes is a Dutchman named Bart Hughes, who makes pseudoscientific claims that the procedure can be used to reach a higher state of consciousness.

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