Early Medical Skull Surgery for Treatment of Post-Traumatic Osteomyelitis 5,000 Years Ago

Abstract

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.

Neuroethics: the institutionalization of ethics in neuroscience

“…Archaeological remains of trepanned skulls, dating from approximately 2500 BC, reveal the frequent practice of neurosurgical procedures in different cultures, probably to address brain disorders [23][24][25] . The Edwin Smith Papyrus, dating from 1500 BC, is the oldest written historical record detailing the relationship between the brain and the clinical manifestations of various neurological diseases 26,27 .…”

A possible case of symbolic trepanation in Neolithic Central Germany

“…6,000 BC ; Crubézy et al, ), Ukraine (Vasilyevka II, ca. 6,900–6,250 cal BC; Lillie, ), Germany (Ensisheim, 5,100 cal BC; Alt et al, ), and Italy (e.g., Catignano and Pontecagnano, 5th century BC; Giuffra & Fornaciari, ; Petrone et al, ). However, the number of cases is growing continuously.…”

“…On the other hand, motivation-led classifications such as surgical-therapeutic, post mortem-ritual (to acquire amulets), or symbolic (partial) trepanations also exist (Jordanov, Dimitrova, & Nikolov, 1988;Kaufmann, Whitaker, & McTavish, 1997;Lidke, 2008;Lisowski, 1967;Wahl, 2012). Symbolic trepanations are often abandoned or planned partial procedures, where the inner table remains intact (Bartucz, 1950;Boev, 1964;Nemeskeri et al, 1965;Petrone et al, 2015). This results in a further differentiation between complete and incomplete (partial) trepanations, though it may be better, in case of the latter, to use more neutral terms such as "manipulation of the cranial vault without opening.…”

The Science of Anatomy: A historical timeline

“…3 Notably, some of these skulls demonstrate evidence of new bone formation around the holes, indicating that some of the victims of these primitive rituals survived the procedure. 4,5 Such practices are thought to have been carried out to release 'evil spirits' from people suffering from mental health disorders as well as other physical symptoms, such as cranial fractures or headaches. 4,5 Until recent times, similar practices were still being performed amongst certain native tribes.…”

“…4,5 Such practices are thought to have been carried out to release 'evil spirits' from people suffering from mental health disorders as well as other physical symptoms, such as cranial fractures or headaches. 4,5 Until recent times, similar practices were still being performed amongst certain native tribes. 6 The Ancient Egyptians (3150-332 BCE)…”