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One of the oldest surgical procedures in the world, trepanning has had a fascinating and surprising history. Through this lesson, you will explore the historic and modern uses of trepanning, and learn about the tools that are used to perform the procedure.

What Is Trepanning?

As you probably are aware, there was a time in human history when diseases and illness were explained in religious, rather than scientific terms. Schizophrenia, for example, was believed by some to have been caused by demonic possession. In some cases, an exorcism was performed to rid the person of these demons, but sometimes a person might have had a hole drilled into his skull in order to let the evil out.

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This practice of drilling a hole into the bone is known as trepanning, also referred to as trepanation or trephination. While it is most commonly associated with the skull, the term can refer to boring a hole in any bone.Of course, in the 21st century most people know that schizophrenia isn’t caused by demons, and there’s no need for an exorcism.

Drilling a hole into a person’s skull, on the other hand, is a treatment that continues to be used in modern medicine.

History and Specialties

In ancient civilizations around the world, it was widely believed that afflictions such as headaches, seizures, or mental illness were caused by spirit possession. In order to relieve the individual’s suffering, a small hole was drilled or scraped into the skull to allow a passage for the spirit to escape.

Research also suggests that trepanning was performed to release the spirit of a person after one had been killed, or to bring one back to life.

Trepanning is one of the oldest surgical procedures in the world and has been performed for a variety of reasons.
trepanning

In later centuries, however, trepanning was performed most commonly for the same reason that it is performed today: to relieve cranial bleeding caused by skull fracture.

In fact, the practice was so common that until the 19th century, those who had suffered a head injury opted for trepanning, regardless of whether or not there was a fracture. Yet, while the practice was common, it also frequently resulted in the patient’s death and was largely abandoned by the early-to-mid 19th century.In the present day, it is most commonly done during a craniotomy, which is a procedure that involves removing a piece of the skull. This might be done to relieve pressure from a subdural hematoma, which is bleeding between the skull and brain, but it can also be required to perform brain surgery or some other procedure that requires accessing the brain.Similarly, a kind of trepanning can be done in cases of subungual hematoma, which occurs when blood collects under the finger or toenails and causes pain.

In this case, doctors will use a small tool to drill a hole into the nail and allow the blood to escape, thus relieving the pressure.Fortunately, in the present there are more modern treatments for the illnesses that once required trephination.

Tools for Trepanning

How trepanning was performed and what tools were used depends largely on when and in what part of the world it was performed. The earliest evidence of the practice indicates that trephination was performed using pieces of flint or glass to scrape a hole into the bone. Evidence collected from later periods of history suggests that similar tools were used to scrape or cut a circular piece of bone that could be lifted from the skull.Beginning in the 17th century, surgeons in Europe and Asia had created sets of tools specifically to be used for the procedure. The set consisted of a series of trepans of various sizes, along with other necessary tools, such as knives and scissors.

The trepan looks similar to a corkscrew with a serrated cork on the end, which was turned by hand to bore a hole into the bone. During the process, the surgeon would drill small holes around the piece to be removed, after which the trepan would be used to complete the procedure.

Surgical trepan kit, c. 18th century.
kit

Despite the passage of centuries, the trephination process has been performed in much the same way, using similar, albeit slightly advanced tools.

In the present day, trephinations are performed using an electric Gigli saw. Named after Italian obstetrician Leonardo Gigli, the saw is a made of flexible wire that is capable of cutting cleanly through bone.

Lesson Summary

Trepanning is a type of surgery in which small holes are drilled into bone, and a piece of bone is removed. It is typically associated with the skull. The surgery is ancient, and research suggests that it has been widely practiced around the world prior to modern medicine.

The reasons for trepanning vary depending on time and location, though in pre-historic and pre-modern civilizations it was often used to relieve the effects of what was believed to be possession.Archeological evidence suggests that in ancient times the procedure was performed using a knife or rock; however, beginning about 500 years ago, surgeons began to use tools known as trepans. In modern trephinations, a type of Gigli saw is used to ensure a clean cut through the bone. Though the reasons are far fewer, trepanning remains a modern surgical procedure during a craniotomy or to relieve pressure caused by a subdural hematoma.

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