The Prehistoric Practice of Trepanation

Abstract

ranial trepanation, a practice dating back thousands of years, is one of the oldest if not a primeval form of cranial C surgery (2). Archaeological digs in Mexico and South America havebrought to light numerous trepanated skulls from the pre-Columbian and Inca civilizations. This practice was common not only in late Prehispanic Peru (the Cuzco region was a major center for trepanation), where thousands of skulls have been discovered, but also was widespread throughout many civilizations across the globe; it was a common practice in surgery in many regions, especially North Africa, right up to recent times (1). Primitive surgeons obviously had primitive instruments (11), such as pointed or sharp cutting tools derived from silica or obsidian (onlymuch later onwere instrumentsmade of bronze used),which they used with incredible ability and knowledge of the anatomy of the skull. Inca surgeons had an in-depth knowledge of cranial anatomy; they avoided certain areas of the cranium and employed methods that reduced damage to several intracranial structures. Many skull trepanationswere practiced in certain areasof the skull, avoiding damage to the underlying venous sinuses,meninges, and brain. Themain techniques for carrying out a craniotomy, as seen in skeletal remain, were scraping, grooving, boring and cutting, and rectangular intersecting incisions (13).