trepanning

trepanning, one of the oldest known surgical procedures, involving the deliberate drilling or scraping of a hole into the human skull. Practiced as early as 7,000 years ago, trepanning, historically, is thought to have been used for various reasons, including for ritualistic and spiritual purposes and as a treatment for head injuries and mental health conditions. The procedure ultimately laid the groundwork for modern craniotomy, in which a section of the skull is removed to gain access to the brain for often highly technical neurosurgical procedures, such as the removal of a tumor.

Evidence of trepanning has been found across a number of prehistoric and ancient cultures. It dates as far back as the Mesolithic and Neolithic periods. Visual signs of bone healing around the openings made in recovered skull samples suggest that some individuals who underwent the procedure survived, despite the availability of only rudimentary tools and techniques and the relative lack of knowledge of human anatomy and physiology. A range of approaches to trepanning appear to have been employed in these early procedures, among them scraping a hole into the skull by using a piece of flint or obsidian.

The use of trepanning continued through early civilizations, including those of ancient Greece, Egypt, and Mesoamerica. Ancient Greek physician Hippocrates has been credited with writing about trepanning and the trephine, a cylindrical blade used for cutting out circular pieces of bone. Galen provided more-detailed accounts of the procedure and its potential uses as well as acknowledging its limitations and potential risks. In the Middle Ages and Renaissance, trepanning was often performed with various cutting tools by barber-surgeons. In the following centuries the procedure was increasingly recognized as a method to treat traumatic injuries to the head. Although a scientific basis for the procedure began to be reasoned, until the 19th century, trepanning was still performed without anesthesia. It was also performed without antisepsis and therefore carried high risk of infection and mortality.

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In the 20th century, trepanning evolved into the modern procedure of craniotomy, a controlled surgical operation performed by neurosurgeons. The trephine also evolved, giving rise to modern trephines used in bone biopsy procedures. These refined instruments are designed for precision, with minimal tissue damage, and often incorporate such features as diamond coatings for grinding through bone, rather than teeth for cutting, as found in older models. Trepanning is now considered an antiquated practice, though it occasionally resurfaces in alternative medicine, and there exists a fringe movement advocating for self-trepanation. However, self-trepanation and nonmedical practice of the procedure are generally considered unsafe and are scientifically unsupported.