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Trepanation holes drilled in a human skull (Museo del Sitio of Monte Albán )
Trephination drill from the 1950s
Amulets (cranial rounds) made from round pieces of human cranial bones, which were created by trepanation (Museum Quintana. Urnfield culture, 9th century BC)
Trepanation cutlery (18th century, Germanic National Museum Nuremberg)

Trepanation ( from Middle Latin trepanatio from ancient Greek τρύπανον trýpanon "drill") describes surgical procedures in which a body cavity that is bony or otherwise firmly enclosed is opened mechanically, usually by drilling.


Skull surgery

In neurosurgery , trepanation refers to skull trepanation ( craniotomy ), i.e. the surgical opening of the skull, either to carry out surgical interventions inside the skull to remove projectiles that have penetrated, or to lower the pressure in the skull (relief strepanation).

The opening of the skull , partially including the meninges , can be done either in the form of a drilling (trepanation) or the temporary removal of part of the skull bone (decompressive craniectomy). Until the piece of bone is reinserted, it is either temporarily stored in the patient's abdominal cavity or stored cryopreserved at −80 °. Two different surgical procedures are used for trepanation of the skull: In osteoplastic trepanation , the piece of bone removed from the skull is used again to close the surgical wound; With the more modern osteoclastic trephination , the resulting wound is closed in another way, for example with implants made of metal or plastic.

Trepanation is a standard procedure with a relatively short operating time, often less than an hour. Catheters and drains can be inserted through the skull hole , for example to relieve a hematoma that occupies space or, in the case of increased intracranial pressure, as a liquor drainage to drain the cerebral fluid ( liquor ).


The Elliot trephination in ophthalmology is a procedure for the therapy of glaucoma in which the eyeball is surgically opened and an artificial drainage is created for the aqueous humor under the conjunctiva .


In dentistry , the opening of the pulp cavity (cavity inside a tooth that contains the "tooth nerve") is called trepanation. This is z. B. necessary before a root canal treatment to show the entrances to the root canals, which can then be cleaned, disinfected and filled as completely as possible with root canal instruments. In addition, trepanation of the jawbone ( Schröder's ventilation ) is rarely carried out in order to create an outlet for the secretion ( pus ) in acute apical periodontitis .

Nail trepanation

Blunt trauma to the toenails or fingernails can lead to a subungual hematoma. Due to the accumulation of blood and the nail as an abutment, painful pressure is exerted on the sensitive tissue. The nail may also lift. The nail is punctured to reduce pain; in the medical field, a sterile cannula is usually used for this, which acts as a rotating drill.


History of the discovery of early skull interventions

From around 1865 skulls with openings were found around the world, the formation of which could not be explained by fighting or accidents. The first investigation into operations on the skull appeared in 1867 by Paul Broca (1824-1880), who had examined a Peruvian skull and found that the individual had survived the operation for a long time. The anthropologist Broca also discovered signs of healing processes at the bone margins in some of the " pre-diluvial " skulls found in 1873 , which proves that successful skull openings in living people had been performed very early on. The French doctor Pierre-Barthélémy Prunières (1828-1893) discovered these skulls in the Lozère department . At that time it was assumed that the pieces of bones were cut out after death in order to wear them as jewelry or amulet.


Woman's skull with T-shaped trephination scar from France
Trepanation from the cave of Nogent-sur-Oise
Trephined skull from the Neolithic Age

The earliest trepanations (skull openings) are known from Morocco ; they have been dated to 12,000 to 11,000 BP . They can be from around 10,000 BC. In the European Mesolithic (e.g. in Ukraine and Russia), Asia (e.g. in Natufia near Jericho (8350 to 6000 BC) and Anatolia) and from the Neolithic in East Asia. (e.g. in China). On the other hand, trepanations in South America could only be made from 400 BC for a long time. Prove. In South America around 3000 trepanations were examined for medical or cultural connections. More than 100 Neolithic trepanations from France, most of them from the Seine-Oise-Marne culture (Départment Lozère), have been anthropologically examined. The trepanations carried out by carriers of the Walternienburg-Bernburg culture were - as can be seen from the healed wound edges - survived in most cases.

The oldest trephined skull in Western and Central Europe is between 5200 and 4900 BC. A male skull to be dated BC, which was found in 1996 in Ensisheim in Alsace . The oldest trepanned skull found in Germany, also belonging to a man, dates from the Middle Stone Age and was found in Jechtingen am Kaiserstuhl . According to studies on the frequency and technique of trepanation in the Neolithic period in Central Europe, published in 1999, the following picture emerges: Of the 113 skulls and eight fragments examined, six showed traces of trephination (five complete). Only four of the skulls were male. In the necropolis of St. Urnel en Plomeur in the Finistère department , a trepanation with healing traces was discovered in the 1950s, in which almost the entire crown is missing.

Stone Age trepanation openings are round or oval in shape, others are rectangular, square or T-shaped (Eastern France). The tools used for trepanation are unknown, the use of mussel shells has been demonstrated by electron microscopy on the bone margins. In rectangular or square trepanations, saw marks are mostly visible in the corners of the preserved skull bones. Vanselow's circular skull is a perforated disc made of bone material that was worn as a talisman, etc. It is an individual find from the deposits of a rinsing area , so that there are no indications of a chronological classification. The almost round bone disc has a diameter of 4.05 to 4.15 cm and is decorated with dots on the surface. A radially decorated and double-perforated disc made from a skullcap was found in a woman's grave on the “Wöllerspfad” ceramic burial ground south of Lauda-Königshofen in the Main-Tauber district .

Skull amulet from a trepanation, Lower Bavarian Archaeological Museum (Landau adIsar)

A common feature of southern Russian skulls examined by the DAI was found that all holes were in the same place on the skull, in the middle, above the occiput. The constant localization of the holes is an unusual observation. In addition, due to its anatomical features, the space is one of the most dangerous for opening a skull. This, as well as the lack of evidence of fractures or diseases of the skull, indicate a ritual reason for the operation.

Since the causes of trepanation cannot be traced back to medical reasons, but rather cultic and ritual acts lead to such surgical interventions, it cannot be ruled out that trepanation discs played a role in sacrificial acts. Especially in bay caves frequently find such skulls from cut bone slices in Urnfield and Early Latène layers. Occasionally they also appear in graves, e.g. B. in an Urnfield Age cremation grave in Wallersdorf . Eight places where trepanation discs were found are known from Upper Franconia : Ahorntal - Kirchahorn, Pegnitz- Buchenbach, Staffelstein-Wolfsdorf , Lichtenfels-Köttel , Heiligenstadt , Hollfeld -Loch, Veldensteiner Forst and Waischenfeld - Rabeneck . A particularly beautiful piece with 64 holes comes from one of the Upper Palatinate Lupberg caves .

It is believed that Stone Age trepanations were made for cultural reasons. One explanation is that invading demons would escape through the created opening or, conversely, that a positive spirit would be given the opportunity to take possession of the person affected. Evidence for the latter is u. a. that mostly no closure of the skull opening was found and the removed bone piece is pierced as an amulet or similar. was carried.

The western tonsure of the Apostle James , for example, goes back to similar ideas .


Trepanation was already known 5000 years ago and can be detected in many regions. It is known from papyri that in the 3rd millennium BC at the latest In Egypt skulls were opened. Some skull finds confirm this. In grave circle B in Mycenae , a c. 1600 BC was found. BC buried man found with traces of trepanation.

The Greek doctor Hippocrates (approx. 460–370 BC) used perforative and crown trephines for cranial openings, and arch drills were also used in ancient times for trephination. Aulus Cornelius Celsus and Paulos von Aigina also use skull trepanations to treat severe skull injuries .

middle Ages

Medical trepanation is documented in the early Middle Ages in southwest Germany. Skull finds from the 6th and 8th centuries suggest that patients mostly survived the operations and infections were rare.

In Hungary between the 10th and 12th centuries symbolic trepanations for cultic purposes took place. They were only done on adults, mostly on men, sometimes in pairs and then mostly symmetrically. These trepanations decreased rapidly with the spread of Christianity and completely disappeared at the beginning of the 12th century.

Modern times

Craniotomy by Hans von Gersdorff
Hieronymus Bosch - detail: Removal of the madness stone

There were a large number of trepanations in the 16th century. At that time, in addition to the typical tools such as hammers, chisels or knives, screwdrivers, as shown by Hans von Gersdorff , or primitive drilling devices were also used. In addition to the real doctors, there were also charlatans and fraudsters who allegedly cut stones, metal or even animals out of the patient's head for money. A fictitious head operation is shown in the painting “The Fool's Healing” by Hieronymus Bosch . Trepanation reached its peak in Central Europe in the 18th and 19th centuries. At that time, mortality also rose rapidly. Modern brain surgery began with the introduction of narcotics and antiseptics .

In 1827, the surgeon Nathan Smith described trepanation as a treatment for osteomyelitis .

Trepanations among the Kisii (East Africa)

The first written records about the East African trepanations come from British and German officials and doctors at the end of the 19th century. These trepanations only became known in Europe around 1957, when British doctors photographed and published successful skull trepanations. They were able to locate between 20 and 35 medicine men who were still opening the skull. For the first time a trephine was filmed in 1958 by the Austrian Max Lersch , which also confirmed that no narcotics were used. In 1979, the German doctor Rolf Meschig counted only six skull openers. Today, skull trepanations without specialist supervision are officially prohibited in Kenya.


In technology, too, trepanation ( English trepanning , drilling, deep drilling) refers to drilling processes, e.g. B. to produce small and very small holes, for example with a laser. In the deep drilling sector , BTA stands for “Boring and Trepanning Association”.

See also


  • Robert Arnott, Stanley Finger, Christopher UM Smith (Eds.): Trepanation. Discovery, history, theory. Swets & Zeitlinger, Lisse et al. 2003, ISBN 90-265-1923-0 .
  • Günter Döderlein: Trepanation from its history: a prehistoric craft. Aesculap-Werke, Tuttlingen 1983, OCLC 313346849 .
  • Carola Hanisch: Hole in the head. In: Adventure archeology. Issue 1, 2005, pp. 50-55. ( Excerpt (PDF; 203 kB) on Wissenschaft-Online)
  • Karl-Maria Heidecker: Skull trepanations in antiquity. In: Würzburg medical history reports. Volume 25, 2006, pp. 113-131.
  • Wolfgang Michael Pahl: Ancient Egyptian skull surgery. Stuttgart 1993, ISBN 3-437-11448-4 .
  • Fritz Ramseier, Gerhard Hotz, Liselotte Meyer: Prehistoric and early historical skull trepanations in Switzerland. From the Neolithic to the Middle Ages. In: Bulletin of the Swiss Society for Anthropology. Volume 11, No. 1/2, 2005, ISSN  1420-4835 , pp. 1-58.
  • Michael Sachs: Trepanation. In: Werner E. Gerabek u. a. (Ed.): Encyclopedia of medical history. de Gruyter, Berlin / New York 2005, ISBN 3-11-015714-4 , p. 1417 ff.
  • Silvia Sprenger: Holes in the head. Exhibition texts for the Museum of Prehistory and Early History. Freiburg 2003.
  • Jürgen E. Walkowitz: The megalithic syndrome. European cult sites of the Stone Age (= contributions to the prehistory and early history of Central Europe. Volume 36). Beier & Beran, Langenweißbach 2003, ISBN 3-930036-70-3 .

Web links

Commons : Trepanation  - collection of images, videos and audio files

Individual evidence

  1. Max Kappis: The surgery of the sympathetic nerve. In: Results of internal medicine and paediatrics. Springer, Berlin / Heidelberg 1924, pp. 562-694.
  2. ^ H. Billet: Treatment of Head Wounds Made by Small Projectiles. Paris Letter - The Twenty-Sixth Annual Meeting of French Surgeons. In: JAMA. Volume 310, No. 5, 2013, p. 540, doi: 10.1001 / jama.2013.5237 .
  3. Michael Solka: Stone Age Surgery. In: Borsuye. Journal for Medicine a. Culture. 10, 39, 1998, p. 18 f.
  4. ^ Frank P. Saul, Julie Mather Saul: Trepanation: Old World and New World. In: Samuel H. Greenblatt, T. Forcht Dagi, Mel H. Epstein (Eds.): A History of Neurosurgery. In Its Scientific and Professional Contexts. Park Ridge 1997, pp. 29-36, here p. 29. He refers in note 22 to Thomas Dale Stewart: Stone age skull surgery. A general review, with emphasis on the New World , Annual Report of the Smithsonian Institution, Washington 1958, pp. 469-491.
  5. Pierpaolo Petrone, Massimo Niola, Pierpaolo Di Lorenzo, Mariano Paternoster, Vincenzo Graziano, Giuseppe Quaremba, Claudio Buccelli: Early Medical Skull Surgery for Treatment of Post-Traumatic osteomyelitis 5,000 Years Ago. In: PLoS ONE. 10, 5, 2015, pp. 1–22, here: p. 1.
  6. a b Ira M. Rutkow: Trephination. In: Archives of Surgery. Volume 135, No. 9, 2000, p. 1119, doi: 10.1001 / archsurg.135.9.1119 .
  7. Maria Mednikova: Prehistoric Trepanations in Russia: Ritual or Surgical? In: Robert Arnott, Stanley Finger, Chris Smith (Eds.): Trepanation. CRC Press, 2005, ISBN 1-4822-8727-7 , p. 163.
  8. ^ A b Frank P. Saul, Julie Mather Saul: Trepanation: Old World and New World. In: Samuel H. Greenblatt, T. Forcht Dagi, Mel H. Epstein (Eds.): A History of Neurosurgery. In Its Scientific and Professional Contexts. Park Ridge 1997, pp. 29-36, here p. 30.
  9. YS Erdal, Ö. D. Erdal: A review of trepanations in Anatolia with new cases. In: International Journal of Osteoarchaeology. Volume 21, No. 5, 2011, pp. 505-534, doi: 10.1002 / oa.1154 .
  10. Han Kangxin, Chen Xingcan: The archaeological evidence of trepanation in early China (PDF). In: Indo-Pacific Prehistoriy Association Bulletin. Volume 27, 2007, 22-27.
  11. ^ Domingo Campillo: Neurosurgical pathology in prehistory. In: Acta Neurochirurgica , Vol. 70, No. 3-4, 1984, pp. 275-290.
  12. ^ Karl-Maria Heidecker: Skull trepanations in antiquity. 2006, p. 113.
  13. J. Piek, G. Lidke, Thomas Terberger, U. of Smekal, MR Gaab: Stone Age skull surgery in in Mecklenburg-a systematic study. In: Neurosurgery. 45, 1, 1999, pp. 147-151.
  14. ^ GC Stevens, J. Wakely: Diagnostic criteria for identification of seashell as a trephination implement. In: International Journal of Osteoarchaeology. Volume 3, No. 3, September 1993, pp. 167-176, doi: 10.1002 / oa.1390030303 .
  15. Archeology in Germany Issue 05/2016, pp 5-7.
  16. Michael M. Rind: Human sacrifice. Regensburg 1998, ISBN 3-930480-64-6 , p. 48.
  17. Trephination . Skews Me; accessed May 10, 2014.
  18. Renate Schafberg: about the man from Pritschöna. In: State Office for Archeology Saxony-Anhalt, State Museum for Prehistory (Hrsg.): Beauty, power and death. 120 finds from 120 years of the State Museum for Prehistory in Halle. Accompanying volume for the special exhibition from December 11, 2001 to April 28, 2002 in the State Museum of Prehistory in Halle / Saale. Leidorf, Halle / Saale 2001, ISBN 3-910010-64-4 : “Undoubtedly, such interventions are ceremonial rituals that form the beginning of a long tradition. Trepanations can be documented in all subsequent epochs up to the present day ”.
  19. Bryony Reid: SURGICAL INSTRUMENTS , "Trepanation", Pitt Rivers Museum, 2005 (online PDF 2.19 MB) ( Memento from October 18, 2017 in the Internet Archive )
  20. Ferdinand Peter Moog: A bow drill with Horaz, Carmina 3, 26, 6. In: Würzburger medical historical reports. 23, 2004, pp. 124-132; here: pp. 128–132.
  21. ^ Karl-Maria Heidecker: Skull trepanations in antiquity. 2006, pp. 122-129.
  22. ^ J. Weber, A. Czarnetzki: Trepanations in the early Middle Ages in the southwest of Germany - indications, complications and outcomes. In: Central Journal for Neurosurgery. Volume 62, No. 1, 2001, p. 10.
  23. Zsolt Bereczki, Antónia Marcsik: trephined Skulls From Ancient population in Hungary . In: Acta Medica Lituanica . Volume 12, No. 1, 2005, pp. 65-69. (PDF; 2.2 MB; 5 pages).
  24. ^ Nathan Smith: Observations on the pathology and treatment of necrosis. In: Philadelphia Monthly Journal of Medicine. Volume 1, 1827, pp. 11-19 and 66-75.
  25. Rolf Meschig: On the history of trepanation with special reference to the skull operations in Kisii in the highlands west of Kenya. Düsseldorf 1983.