Trepanation: A How-To Guide

Despite the saying, sometimes, you really do need a hole in the head. Evidence for trepanation (making a hole in the skull) appears in the archaeological record across cultures and time and it is the first type of surgery we know of. Not only does the procedure have different characteristics depending on when and where it was carried out, there’s increasing evidence that it really was done for medical reasons. Allow me to illustrate.

Method 1: Scraping with a flint blade

Several skulls found in the Altai region of Siberia demonstrate the scraping type of trepanation. These surgeries are performed with a blade rather than a flint knife and use a circular slicing motion. Surgeons recently attempted to recreate this method. Their conclusion? It took a great deal of medical skill and anatomical knowledge to do successfully.

Method 2: Sawing or chiseling a circular skull

This Bronze Age skull from Jericho demonstrates the second method of trepanning by incising a circular groove to remove a disk of bone. Incredibly there are four four holes, one of which is completely healed meaning this person was subjected to surgery on several occasions!

Method 3: Drilling several connected holes

Peru has a vast array of examples of trepanation. In one incredible skull specimen, archaeologists have found a person survived a trepanation in life, and after death his skull was used to test the drills that are used for the third type of trepanation. If the drill wasn’t bad enough, this method may also require the use of a hammer and chisel to remove the bone piece.

Method 4: Incising linear grooves

The way of slicing into bone in a cross-hatch pattern to make a square hole is common is Mesoamerica. There are lots of skulls that have these types of scars. We also find the knives that would have been used – A particularly nice example dating to 800 AD was found in Peru and is decorated with figures using a similar knife to perform the surgery.

Method 5: Drilling a single burr hole with a flint

A skull from Vasilyevka II cemetary, Ukraine, dated to 7000BCE, is the first known successful cranial surgery. This trepanation was likely carried out by using a worked flint blade to drill a small hole through the frontal bone. Though it is difficult to tell because the bone has actually entirely healed.

So we know how, but why cut a hole in a skull?

Later texts describe the medical benefits of trepanation for head injuries, but the earliest instances of trepanation are known only from physical evidence, which means the motivation behind the surgery is still up for debate.

But… There are two distinct possibilities. The first is that it was performed for medical reasons. There are some trepanned skulls that show evidence of trauma or illness, which suggests people knew it was possible to relieve pain from pressure on the brain by cutting into the skull.

In fact, there’s one skull that was found in Siberia which shows evidence of head injury. On the inside of the skull, you can even see the impression left by a blood clot, which would have caused the patient a great deal of pain and nausea. In this case, it looks like the surgery was carried out to target this very specific source of pain.

On the other hand, there are many skulls that show no signs of trauma or sickness, which has lead some researchers to suggest trepanation was also carried out for spiritual reasons, or even in an attempt to treat mental illness.

So, the practice of trepanation has lasted until modern times, and the reasons for cutting into the skull have varied, as have the tools (thankfully for us!). Nevertheless, it is incredible (if also a little alarming) to know that as much as 10,000 years ago people were performing a surgery that still happens today.