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Trepanation

Trepanation:18th century French illustration of trepanation
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18th century French illustration of trepanation

Trepanation (also known a 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).

A trepan may also refer to a rock-boring tool used for sinking mine shafts. It is also a kind of industrial drill bit, commonly used to bore large diameter holes in metal and sometimes referred to as a BTA drill. The drill characteristically leaves a core.

Trepanation was 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.


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Trepanation in pre-Columbian Mesoamerica

Main article: Trepanation in Mesoamerica

In pre-Columbian Mesoamerica, evidence for the practice of trepanation and an assortment of other cranial deformation techniques comes from a variety of sources, including physical cranial remains of pre-Columbian burials, allusions in iconographic artworks and reports from the post-colonial period.

Among New World societies, trephinning is most commonly found in the Andean civilizations such as the Inca.[1] Its prevalence among Mesoamerican civilizations is much lower, at least judging from the comparatively few trepanated crania which have been uncovered.[2]

The archaeological record in Mesoamerica is further complicated by the practice of skull mutilation and modification which was carried out after the death of the subject, in order to fashion "trophy skulls" and the like of captives and enemies. This was a reasonably widespread tradition, illustrated in pre-Columbian art which on occasion depicts rulers adorned with or carrying the modified skulls of their defeated enemies, or of the ritualistic display of sacrificial victims. Several Mesoamerican cultures used a skull-rack (known by its Nahuatl term, tzompantli ) on which skulls were impaled in rows or columns of wooden stakes.

Even so, some evidence of genuine trepanation in Mesoamerica (i.e., where the subject was living) has been recovered.

The earliest archaeological survey[3] published of trepanated crania was a late 19th-century study of several specimens recovered from the Tarahumara mountains by the Norwegian ethnographer Carl Lumholtz.[4] Later studies documented cases identified from a range of sites in Oaxaca and central Mexico, such as Tilantongo, Oaxaca and the major Zapotec site of Monte Albán. Two specimens from the Tlatilco civilization's homelands (which flourished around 1400 BCE) indicate the practice has a lengthy tradition.[5]

A study of ten low-status burials from the Late Classic period at Monte Albán concluded that the trepanation had been applied non-therapeutically, and, since multiple techniques had been used and since some people had received more than one trepanation, concluded it had been done experimentally. Inferring the events to represent experiments on people until they died, the study interpreted that use of trepanation 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 in the Oaxacan highlands.[citation needed]

Specimens identified from the Maya civilization region of southern Mexico, Guatemala and the Yucatán peninsula show no evidence of the drilling or cutting techniques found in central and highland Mexico. Instead, the pre-Columbian Maya seemed to have utilised an abrasive technique which ground away at the back of the skull, thinning the bone and sometimes perforating it, similar to the examples from Cholula. Many of the skulls from the Maya region date from the Postclassic period (ca. 950–1400), and include specimens found at Palenque in Chiapas, and recovered from the sacred cenote at the prominent Postclassic site of Chichen Itza in northern Yucatán.[6]

Trepanation in Modern Times

A small number of individuals in contemporary times advocate trepanation for various reasons, such as to achieve higher consciousness. Most of these nonmedical trepanations are performed by unlicenced amateurs, or in at least a few cases, by individuals on themselves (see above). The aforementioned Feilding ran for Parliament twice, on the platform that trepanation should be provided under the British National Health Plan (She garnered 49 votes on her first run and 139 on the second). One group, known as the International Trepanation Advocacy Group, claims to have taken 14 people to Mexico for trepanations by professional surgeons (although in most countries elective trepanation would be grounds for a doctor losing one's licence and incurring criminal prosecution).Pete Halvorson, the senior director of the International Trepanation Advocacy Group claims this after he had a trepanation, “I find myself busy long after others are asleep. I'm ready to start again early in the A.M. The truth is I can't get enough of life” (http://www.trepan.com/_index.html). There is very little theory or merit behind this explanation because his behavior can’t be directly linked to his trepanation.

Trepanation in literature

Trepanation:Trepanated skull, Iron age. The patient survived the operation.
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Trepanated skull, Iron age. The patient survived the operation.
"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.

Lord Asriel said, "I found his [Stanislaus 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."
The fourth chapter of the second novel is called "Trepanning" and features a museum with a display of a prehistoric trepannation.
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.


Trepanation in film

Spoiler warning: Plot and/or ending details follow.
Spoilers end here.

Additionally, an x-files episode is based on the practice of Trepanation

See also

Notes

  1. ^ Tiesler (2003a)
  2. ^ Ibid.
  3. ^ According to Tiesler (2003a).
  4. ^ Lumholtz's study was published in the journal American Anthropologist (Lumholtz 1897).
  5. ^ Romero (1970).
  6. ^ Tiesler (1999).

References


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Articles with unsourced statements | History of neuroscience | Neurology | Neurosurgery | Surgery | Quackery | Body modification

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