Trepanation

Trepanation (also known as trepanning, trephination, trephining or burr hole) is surgery in which a hole is drilled or scraped into the Human 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, such as intracranial pressure monitoring.

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. Cave paintings indicate that people believed the practice would cure epileptic seizures, migraines, and mental disorders [cite book |author=Brothwell, Don R. |year=1963 |title=Digging up Bones; the Excavation, Treatment and Study of Human Skeletal Remains |location=London |publisher=British Museum (Natural History) |oclc=14615536 |pages=126] perhaps in the belief to cure diseases by letting evil spirits escape. The bone that was trepanned was kept by the prehistoric people and worn as charms to keep evil spirits away. Evidence also suggests that trepanation was primitive emergency surgery after head wounds to remove shattered bits of bone from a fractured skull and clean out the blood that often pools under the skull after a blow to the head. Such injuries were typical for primitive weaponry such as sling shots and war clubs [ [http://web.archive.org/web/20010202194200/%68ttp://www.trepanation.com/master10.htm The Skull Doctors - www.trepanation.com] ]

The modern medical procedure of corneal transplant surgery also uses a technique known as trepanning or trephining. This operation, however, is conducted on the eye (not the skull), with an instrument called a trephine.

History

Old World

Trepanation is perhaps the oldest surgical procedure for which there is evidence, [Cite book |author=Capasso, Luigi |year=2002 |title=Principi di storia della patologia umana: corso di storia della medicina per gli studenti della Facoltà di medicina e chirurgia e della Facoltà di scienze infermieristiche |location=Rome |publisher=SEU |isbn=8887753652 |oclc=50485765 |language=Italian] and in some areas may have been quite widespread. Out of 120 prehistoric skulls found at one burial site in France dated to 6500 BC, 40 had trepanation holes.cite book |author=Restak, Richard|chapter=Fixing the Brain |title=Mysteries of the Mind |publisher=National Geographic Society |location=Washington, D.C. |year=2000 |isbn=0-792-27941-7 |oclc=43662032] Many prehistoric and premodern patients had signs of their skull structure healing; suggesting that many of those that proceeded with the surgery survived their operation.

Trepanation was also practiced in the classical and Renaissance periods. Hippocrates gave specific directions on the procedure from its evolution through the Greek age, and Galen elaborates on the procedure, too.

During the Middle Ages and the Renaissance, trepanation was practiced as a cure for various ailments, including seizures and skull fractures. Out of eight skulls with trepanations from the 6th-8th centuries in southwestern Germany, seven skulls show clear evidence of healing and survival after trepanation suggesting that the survival rate of the operations was high and the infection rate was low.cite journal|author=Weber, J. |coauthors=and A. Czarnetzki |title=Trepanationen im frühen Mittelalter im Südwesten von Deutschland - Indikationen, Komplikationen und Outcome |journal=Zentralblatt für Neurochirurgie |volume=62 |issue=1|pages=10 |year=2001 |issn=0044-4251 |doi=10.1055/s-2001-16333 |language=German]

Pre-Columbian 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 pre-Incan culture such as the Paracas Ica situated in what now is Ica located South of Lima. Its prevalence among Mesoamerican civilizations is much lower, at least judging from the comparatively few trepanated crania which have been uncovered.Cite paper|author=Tiesler Blos, Vera|date=2003 |title=Cranial Surgery in Ancient Mesoamerica |publisher=Mesoweb |url=http://www.mesoweb.com/features/tiesler/Cranial.pdf |format=PDF|accessdate=2006-05-23]

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 published of trepanated crania was a late 19th-century study of several specimens recovered from the Tarahumara mountains by the Norwegian ethnographer Carl Lumholtz. [cite journal |author=Lumholtz, Carl |authorlink=Carl Sofus Lumholtz|title=Trephining in Mexico |journal=American Anthropologist |volume=10 |issue=12 |pages=389 |year=1897 |doi=10.1525/aa.1897.10.12.02a00010] 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 BC) indicate the practice has a lengthy tradition. [Cite book|author=Romero Molina, Javier|chapter=Dental Mutilation, Trephination, and Cranial Deformation |title=Handbook of Middle American Indians, Vol. 9: Physical Anthropology |editor=T. Dale Stewart (volume ed.) |others=Robert Wauchope (series ed.) |publisher= University of Texas Press |location=Austin |year=1970 |edition=2nd. edition (revised)|isbn=0-292-70014-8|oclc=277126]

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.Fact|date=February 2007

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. [cite paper|author=Tiesler Blos, Vera|date=1999 |title=Rasgos Bioculturales Entre los Antiguos Mayas: Aspectos Culturales y Sociales |publisher=Doctoral thesis in Anthropology, UNAM |language=Spanish ]

Modern medicine

Trepanation is a treatment used for epidural and subdural hematomas, and for surgical access for certain other neurosurgical procedures, such as intracranial pressure monitoring. Modern surgeons generally use the term craniotomy for this procedure. The removed piece of skull is typically replaced as soon as possible. If the bone is not replaced, then the procedure is considered a craniectomy.

Voluntary trepanation

Although considered today to be pseudoscience, the practice of trepanation for other purported medical benefits continues. The most prominent explanation for these benefits is offered by Dutchman Bart Huges (alternatively spelled Bart Hughes). He is sometimes called Dr. Bart Hughes although he did not complete his medical degree. Hughes claims that trepanation increases "brain blood volume" and thereby enhances cerebral metabolism in a manner similar to cerebral vasodilators such as ginkgo biloba. No published results have supported these claims.

Other modern practitioners of trepanation claim that it holds other medical benefits, such as a treatment for depression or other psychological ailments. In 2000 two men from Cedar City, Utah were prosecuted for practicing medicine without a license after they performed a trepanation on an English woman to treat her chronic fatigue syndrome and depression. [ [http://www.rcfp.org/news/2000/1016trepan.html Reporters Committee for Freedom of the Press (2000) "ABC ordered to hand over unedited head-drilling tapes"] ]

However, individuals may practice non-emergency trepanation for psychic purposes. A prominent proponent of the modern view is Peter Halvorson, who drilled a hole in the front of his own skull to increase "brain blood volume".

In a chapter of his book, "Eccentric Lives & Peculiar Notions", John Michell describes a British group that advocates self-trepanation to allow the brain access to more space and oxygen. The chapter is called "The People With Holes in their Heads". Michell cites Bart Huges as pioneered the idea of trepanation specifically his 1962 monograph, "Homo Sapiens Correctus", as most cited by advocates of self-trepanation. Among other arguments, he contends that since children have a higher state of consciousness and children's skulls are not fully closed one can return to an earlier, childlike state of consciousness by self-trepanation. Further, by allowing the brain to freely pulsate Huges argues that a number of benefits will accrue.

Michell quotes a book called "Bore Hole" written by Joey Mellen. At the time the passage below was written, Joey and his partner, Amanda Feilding, had made two previous attempts at trepanning Mellen. The second attempt ended up placing Mellen in the hospital, where he was scolded severely and sent for psychiatric evaluation. After he returned home, Mellen decided to try again. He describes his third attempt at self-trepanation:

After some time there was an ominous sounding schlurp and the sound of bubbling. I drew the trepan out and the gurgling continued. It sounded like air bubbles running under the skull as they were pressed out. I looked at the trepan and there was a bit of bone in it. At last!

Amanda Feilding also performed a self-trepanation with a drill, while her partner Joey Mellen filmed the operation, in the film titled Heartbeat in the Brain. The film has since been lost. Portions of the film can be seen, however, in the documentary "A Hole in the Head".

In popular culture

Trepanation is a significant plot point in two sections of the His Dark Materials series by Phillip Pullman, in which it allows a greater quantity of Dust to fall on the recipients.

Fictional mathematician Max Cohen in the movie Pi performs a trepanation on himself using a drill.

In the "Bones" episode "The Headless Witch in the Woods," the Squints discover a skull with evidence of trepanation.

The Army of the Third Eye in the role playing game Delta Green use Trepanation to expose and destroy the alien Insects from Shaggai.

The character Mason in the TV Show Dead Like Me performed a trepanation on himself in an attempt to enhance a drug-induced high, resulting in his death.

The Oxford Murders mentioned of a mathematician attempts to drill a hole in his head to think more in non linearly like his mental patients which he noticed are quite brilliant at times to help solve complicated math problems, although the word trepanation was not mentioned.

On the TV show episode "Brain Drain", a mentally average man uses a cursed two-seated trepanation device transfers the intelligence of one of a victim to him through a hole at the base of the skull. The victim dies sometime after..

See also

* Mütter Museum
* Lobotomy

References

External links

* [http://www.steinergraphics.com/surgical/006_17.6.html WHO surgical instructions on burr holes]
* [http://skepdic.com/trepanation.html Skeptic's Dictionary entry about Trepanation]
* [http://scienceblogs.com/neurophilosophy/2008/01/an_illustrated_history_of_trep.php An illustrated history of trepanation]
* [http://scienceblogs.com/neurophilosophy/2008/08/lunch_with_heather_perry.php Interview with self-trepanner Heather Perry]