Trepanations in non-adults of the 16th to 18th C. The osteological series of the Church of the Assumption of Valdepeñas (Ciudad Real, Spain)

OBJECTIVE

To investigate the presence of trepanations in an early Modern Age, skeletal collection documented in medical treatises but infrequently reported in osteological collections.

MATERIALS

Analyses were conducted on 387 non-adult crania from the ossuary in the church of the Assumption of Valdepeñas (16th - 18th C.), Ciudad Real, Spain.

METHODS

All complete or semi-complete crania of non-adults (aged 3-20 years) were macroscopically examined.

RESULTS

Trepanation was detected in two adolescents aged 14 and 20 years; no evidence of their survival was observed.

CONCLUSIONS

These findings suggest that trepanation was carried out in rural areas as Valdepeñas in the 16th-18th centuries, where the selection of instruments indicates knowledge of contemporaneous medical treatises.

SIGNIFICANCE

The present study provides new data on trepanation and how it was performed in adolescents during this period.

LIMITATIONS

Understanding the motive for these interventions is highly challenging in the absence of bone lesions, and their occurrence is likely underestimated due to the scant research in skeletal remains from the early Modern Age.

SUGGESTIONS FOR FUTURE RESEARCH

Further palaeopathological analyses of osteological collections from this period will provide more information about how this surgical technique was perfected.

3D reappraisal of trepanations at St. Cosme priory between the 12th and the 15th centuries, France

OBJECTIVE

This study aims to place trepanation in a medieval therapeutic context by addressing its medical use in neurological disorders and by testing the existence of particular dietary care for the sick.

MATERIALS

Six cases of trepanation found at the St. Cosme priory (La Riche, France) dated from the 12th-15th centuries.

METHODS

Neurological health was explored by geometric morphometrics by comparing the six cases to 68 skulls and 67 endocraniums belonging to individuals from the same period and geographical area. Trepanned diet was investigated by carbon and nitrogen isotopes and compared to 49 individuals from the same site.

RESULTS

The study of shapes suggests a possible pathological state for four subjects. The diet of the trepanned is not different from the rest of the population.

CONCLUSIONS

The treatment of neurological disorders emerges as the main therapeutic motivation in the corpus, contrary to the reports from the ancient surgical treatises. A specific diet for the sick is not highlighted.

SIGNIFICANCE

Geometric morphometrics is rarely used in paleopathology and the results suggest a potential of this type of analysis in the identification of pathological cases. The results on therapeutic motivations and diet do not fit the descriptions from ancient medical sources.

LIMITATIONS

The study of forms did not lead to definitive diagnosis. The isotopic study does not allow us to appreciate all the aspects of the diet.

SUGGESTIONS FOR FURTHER RESEARCH

A geometric morphometric study of the skulls and endocraniums of individuals with a known neurological condition would allow a better appreciation of the link between shapes and pathologies.

A case of Avar period trepanation from Croatia

The Avar period cemetery of Nuštar, situated in continental Croatia, is dated to the 8th and the beginning of the 9th century. Rescue archaeological excavation yielded 196 burials. During analysis of human skeletal remains, an individual with a large cranial lesion caused by trepanation was found. Trepanation is a surgical procedure performed on the skull in order to remove a fragment of the bone using a sharp instrument or drill. It has been practiced in various regions since the prehistoric period for both medical and ritual reasons. The aim of this paper is to provide a description of the observed lesion based on macroscopic appearance accompanied by radiography, computed tomography scanning and 3D optical scanning. Furthermore, possible cause and employed technique are taken into consideration, as well as cultural and historical implications of the case.

History of Chronic Subdural Hematoma

Trephination or trepanation is an intentional surgical procedure performed from the Stone Age. It looks like escaping a black evil from the head. This technique is still used for treatment of chronic subdural hematoma (SDH). Now, we know the origin, pathogenesis and natural history of this lesion. The author try to explore the history of trephination and modern discovery of chronic SDH. The author performed a detailed electronic search of PubMed. By the key word of chronic SDH, 2,593 articles were found without language restriction in May 2015. The author reviewed the fact and way, discovering the present knowledge on the chronic SDH. The first authentic report of chronic SDH was that of Wepfer in 1657. Chronic SDH was regarded as a stroke in 17th century. It was changed as an inflammatory disease in 19th century by Virchow, and became a traumatic lesion in 20th century. However, trauma is not necessary in many cases of chronic SDHs. The more important prerequisite is sufficient potential subdural space, degeneration of the brain. Modifying Virchow's description, chronic SDH is sometimes traumatic, but most often caused by severe degeneration of the brain. From Wepfer's first description, nearly 350 years passed to explore the origin, pathogenesis, and fate of chronic SDH. The nature of the black evil in the head of the Stone Age is uncovering by many authors riding the giant's shoulder. Chronic SDH should be categorized as a degenerative lesion instead of a traumatic lesion.

Deep brain stimulation for psychiatric disorders: where we are now

Fossil records showing trephination in the Stone Age provide evidence that humans have sought to influence the mind through physical means since before the historical record. Attempts to treat psychiatric disease via neurosurgical means in the 20th century provided some intriguing initial results. However, the indiscriminate application of these treatments, lack of rigorous evaluation of the results, and the side effects of ablative, irreversible procedures resulted in a backlash against brain surgery for psychiatric disorders that continues to this day. With the advent of psychotropic medications, interest in invasive procedures for organic brain disease waned.

Diagnosis and classification of psychiatric diseases has improved, due to a better understanding of psychiatric patho-physiology and the development of disease and treatment biomarkers. Meanwhile, a significant percentage of patients remain refractory to multiple modes of treatment, and psychiatric disease remains the number one cause of disability in the world. These data, along with the safe and efficacious application of deep brain stimulation (DBS) for movement disorders, in principle a reversible process, is rekindling interest in the surgical treatment of psychiatric disorders with stimulation of deep brain sites involved in emotional and behavioral circuitry.

This review presents a brief history of psychosurgery and summarizes the development of DBS for psychiatric disease, reviewing the available evidence for the current application of DBS for disorders of the mind.

Early medical skull surgery for treatment of post-traumatic osteomyelitis 5,000 years ago

Here we describe the findings of a unique example of the early techniques adopted in neurosurgery around 5000 years ago, consisting in a double well healed skull trephination associated with a post-cranial traumatic event occurring intra vitam to a young male from the Early Chalcolithic cemetery of Pontecagnano (South Italy, ca. 4,900 - 4,500 cal BP). Morphological, X-ray and 3D-CT scan skull-cap evaluation revealed that the main orifice was produced by scraping, obtained by clockwise rotary motion of a right-handed surgeon facing the patient, while the partial trephination was carried out by using a stone point as a drilling tool. In both cases, bone regrowth is indicative of the individual's prolonged postoperative survival and his near-complete recovery. The right femur shows a poorly healed mid-shaft fracture presumably induced by a high energy injury, and a resulting chronic osteomyelitis, affecting both femurs by hematogenous spread of the infection. Our observations on the visual and radiological features of skull and femur lesions, along with evidence on the timing of experimental bone regrowth vs. healing of lower limb fractures associated to long-term bone infections now suggest that this young man underwent a double skull trephination in order to alleviate his extremely painful condition induced by chronic osteomyelitis, which is thought to have been the cause of death.