Prehistoric trepanation in the Cuzco region of Peru: A view into an ancient Andean practice

Abstract

In this study, patterns of prehistoric trepanation in the southern highlands of Peru were examined through an analysis of 11 Cuzco-region burial sites. Trepanations were found in 66 individuals, with several individuals exhibiting more than one trepanation, for a total of 109 perforations observed. The predominant methods used were circular cutting and scraping-methods that proved highly successful with an overall 83% survival rate and little ensuing infection. Survival rates showed a significant increase over time, apparently reflecting improvements in trepanation technique through experimentation and practical experience. Practitioners avoided certain areas of the cranium and employed methods that reduced the likelihood of damage to the cerebral meninges and venous sinuses. In many cases, trepanation as a medical treatment appears to have been prompted by cranial trauma, a finding that corroborates other studies pointing to cranial trauma as a primary motivation for the surgical procedure.

Evidence of trepanations in a medieval population (13th-14th century) of northern Spain (Gormaz, Soria)

“…Following this view, it has been proposed that in ancient times, prehistoric men may have decided to treat head lesions after observing that they could involve the development of mental disorders such as loss of consciousness, memory corruption, convulsions and even changes in behavior (Finger, 1994). Several authors also consider this as a plausible hypothesis (see Walker, 2001;Liu and Apuzzo, 2003;Andrushko and Verano, 2008), even though the absence of written testimonies from these times makes it impossible to determine the knowledge that these cultures had about the brain and its mental functions.…”

“…Trepanations are also well represented throughout the world, and their existence has been documented in skeletal remains from every continent (Wells, 1964;Lisowski, 1967;Margetts, 1967;Campillo, 1984;Merbs, 1989;Alt et al, 1997;Capasso et al, 2002;Blos, 2003;Andrushko and Verano, 2008;Redfern, 2010). However, the frequency of trepanantions is higher in certain parts of the world, notably South America: Peru is recognized as a major source of ancient trepanned crania (Campillo, 1984;Verano and Finger, 2009;Verano and Andrushko, 2010), the earliest of which was dated between 200 BCE and 400 AD and came from the burial site of Paracas (Verano, 2003).…”

“…Female cases of trepanation have been found even in very ancient times (see Prioreschi, 1996), but are uncommon, as this procedure seems to have been predominantly carried out on adult males (Piggott, 1940;Campillo, 1984;Jennbert, 1991). Examples of trepanned children skulls are also very rare (Jordanov et al, 1988;Verano, 2003;Andrushko and Verano, 2008) and some authors have proposed that this probably reflects (i) the lower childhood frequency of the susceptible disorders that were treated by cranial surgery; (ii) an uneven conservancy of fragile skeletal remains; or (iii) a reluctance of ancient physicians to expose children to potentially life-threatening surgical techniques (MarianiCostantini et al, 2000).…”

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 .…”

Evolution of cranioplasty techniques in neurosurgery: historical review, pediatric considerations, and current trends

“…100,104 Similar historical evidence has been found from ancient Celtic, Persian, Turkish, and South American civilizations. 3,32,34,97,106 Few subsequent advances were made in the practice of cranioplasty until Galen (130-200 ad) and Avicenna (980-1037 ad) started using moistened linen over wounds and performed regular dressing changes to promote wound granulation, a practice that was followed for centuries. 82,104 In 1505 ad, the Ottoman surgeon Ibrahim bin Abdullah published the first known written case of cranioplasty in his book, Wonders of Surgeons (Alâim-i Cerrâhin), a case that was treated using goat-and canine-derived xenografts.…”