Elsevier

World Neurosurgery

Volume 81, Issue 2, February 2014, Pages 431-435
World Neurosurgery

Peer-Review Report
Neurosurgery During the Bronze Age: A Skull Trepanation in 1900 BC Greece

https://doi.org/10.1016/j.wneu.2013.01.044Get rights and content

Objective

Paleoneurosurgery represents a comparatively new developing direction of neurosurgery dealing with archaeological skull and spine finds and studying their neurosurgical aspects. Trepanation of the cranial vault was a widespread surgical procedure in antiquity and the most convincing evidence of the ancient origin of neurosurgery. The present study considers a case of trepanation from the Middle Bronze Age Greece (1900–1600 B.C.).

Methods

The skull under study belongs to skeletal material unearthed from Kirra, Delphi (Central Greece). Macroscopic examination and palpation, as well as three-dimensional computed tomography, were used in this study.

Results

There is osteological evidence that the skull belongs to a man who died at 30–35 years of age. The procedure of trepanation was performed on the right parietal bone. Both macroscopic and computed tomography evaluation demonstrate an intravital bone reaction at the edges of the aperture. Projected on the right surface of the brain, the trepanation is located on the level of the central groove. The small dimensions and the symmetrical shape of this hole give us an indication that it was made by a metal tool.

Conclusion

We conclude that this paleopathological case provides valuable information about the condition of life and the pre-Hippocratic neurosurgical practice in Bronze Age Greece.

Section snippets

Background

Paleoneurosurgery represents a comparatively new, still-developing aspect of neurosurgery that comprises the identification of archaeological skull and spine finds and the study of their neurosurgical aspects 7, 13. Skull trepanation of the cranial vault, one of the most intriguing paleoneurosurgical techniques, was widespread in antiquity. This neurosurgical operation (also called trephination or trephinement) involves the removal of one or more pieces of bone without causing any damage to the

Objectives

The aim of the present paper is to present one of the most ancient cases of trepanation on a skull excavated in Greece. The approach to this trepanation case (FOP 1/S 9; 1900 BC) has been by macroscopic observation (16), whereas this paper attempts documentation via computed tomography (CT) methods.

As for the archaeological context, Kirra is located approximately 10 km northwest Delphi. According to the archaeological evidence, this ancient city developed significant cultural activity during

Materials and Methods

The skull (FOP 1/S 9) was unfortunately the only part of the skeleton that remained intact during the archaeological excavation. Both macroscopic examination and three-dimensional CT were used in this study.

Macroscopic Evaluation

The relatively large size of this skull and also the excessive mastoid process and supraorbital arches seem identify it as belonging to a man. The cranial sutures give us an indication that the man from Kirra died at 30–35 years of age. Trepanation was performed on the right parietal bone (Figure 2). The healed aperture of this ancient operation has relatively small dimensions (14 × 10 mm). The actual hole has shorter dimensions (8 × 7.5 mm). The shape of the actual hole is oval or ellipsoid.

Observations and Discussion

Hippocrates was the first author who medically described trepanation, although he was cautious in practicing it. He provided the first detailed description of human skull anatomy and influenced the gradual development towards modern neurosurgery (18). However, according to the archaeological data, the technique of trepanation had been known in the Greek area since the Early Bronze Age (18). This current study presents a case of trepanation dating to a prehistoric period, approximately 2

Conclusion

We describe a skull trepanation from the Bronze Age Greece. Although there is not enough data about the cause and the goals of this operation, no one should dispute the knowledge and the abilities of the ancient neurosurgeon who managed to design rightly and operate successfully lengthening the life of the young inhabitant of Kirra. Given the exceptional fact that, through a misty path, trepanation has survived from the Bronze Age through to modern practice, we can reasonably bear that, indeed,

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    Conflict of interest statement: The authors declare that the article content was composed in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

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