Trepanation ( v. französ. Trephine drill) is a term used in medicine and describes operational procedures in which most bony or in any other manner determined enclosed spaces be opened mechanically.

In neurosurgery is called trepanation with the craniotomy, ie the operative opening of the skull, either to undertake surgical procedures in the interior of the skull, or even to reduce intracranial pressure, intracranial pressure. One speaks in this case of Entlastungstrepanation. The opening of the skull, partially including the meninges can be done either in the form of a hole or a sawn piece of bone. By replacing the piece of bone that is often stored in the abdomen. Thus, it is growing faster again. In the trepanation of the skull two different surgical procedures are used: In the osteoplastic trepanation, the removed piece of bone from the skull is used again to close the surgical wound. In the more modern osteoclastic trephination, the resulting defect is closed by other means, such as by implants made ​​of metal or plastic.

Trephination in the art refers to a specific method, small and very small holes, such as with a laser to produce.

The Elliot trephination in ophthalmology is a method for the treatment of glaucoma, in which the eyeball is opened by surgery and an artificial drainage of the aqueous humor is created under the conjunctiva.

In dentistry refers to the opening of the pulp cavity as trepanation. This is, for example, before a root canal necessary for the inputs of the root canals present which can then be cleaned with root canal instruments, disinfection and preferably completely filled.



Trepanation ( skull openings ) can already be detected even by 10,000 BC in the Natufian and later worldwide.

  • The French doctor Pierre Barthélémy Prunières (1828-1893) discovered in 1873 in the department of Lozère several perforated Stone Age skull. At that time it was assumed that the bone fragments were excised after death, to be worn as jewelry or amulet.
  • The French anthropologist Paul Broca (1824-1880) discovered in some of the skull in 1873 found signs of healing processes at the bone edges, which was evidence that successful skull openings were performed on living people in the early days.
  • In St. Urnel s Plomeur Finistère was in the 1950s, among others a trepanation with healing traces discovered in almost all the apex ceiling is missing.
  • A radially decorated and double perforated, created from a skull disk was found in a woman's grave on the Corded Ware burial ground " Wöller path " south of Lauda- Königshofen in the Main- Tauber-Kreis.

In Europe, more than 450 trepanation could be detected from the Neolithic period. The most extensive findings is available with more than 100 Neolithic trepanation from France. Most skulls are from the department of la Lozere and the Seine -Oise -Marne culture ( SOM culture). In Central Europe can be the beginnings of trepanning (from about 4500 BC) to provide very middle Neolithic. As one of the oldest proven trepanation, the engagement force on the skull of a man of the Linear Pottery, possibly also the La - Hoguette culture ( about 5500-4900 BC) from Alsace burial ground HOENHEIM - Suffelsweyersheim in France. Trepanation in Germany are known from the Funnel Beaker Culture ( TBK ), the Walternienburg - Bernburg culture and the Corded Ware culture. The trepanation made ​​by makers of Walternienburg - Bernburg culture - as you can see from the unhealed wound edges - have survived in most cases. However, the data base is too small to close it slightly.

Trephined people rarely ended in earth graves, but during the TBK in megalithic sites. According to studies on Trepanationshäufigkeit and Technology in the Neolithic Age by J. Piek, G. Lidke, T. Terberger, U. of Smekal and MR Gaab the following picture emerges: Of the 113 found or examined skulls and eight fragments identified six Trepanationsspuren ( five completed ) on. Only four of the skulls were male.

From ancient papyrus writings is known that in the 3rd millennium BC in ancient Egypt skulls were opened at the latest. Some of the skulls findings confirm this. In South America, several graves were ( about 2000 years old ) with trephined skulls and surgical tools found. Most skull showed healing processes.

Whether prehistoric trepanation have been made for medical or religious reasons, is controversial. A religious explanation is that invading demons would escape through the opening created or that, conversely, a positive spirit and would open the opportunity to take possession of the person concerned. Evidence for the latter is, inter alia, that the wound was not closed, but pierced the removed piece of bone and as an amulet or the like. was born. In a similar performances goes back eg the Western tonsure of the apostle James.

Modern Medicine

The Greek physician Hippocrates (ca. 460-370 BC) used for skull openings Perforativ and Kronentrepan. Christianity forbade the early Middle Ages, trepanation from living people, so there were very few secret head operations. It was only in the 13th century was often trepanated again. A variety of trepanation there was in the 16th century. At that time you sat down, one next to the typical tools such as hammers, chisels and knives, also Schraubapparate or primitive drills. In addition to the real doctors there were charlatans and swindlers, who cut the patient against money allegedly stones, metal or even animals from the head. A head operation is " Fools healing " ( The Stone Operation ) by Hieronymus Bosch depicted in the painting. The highlight there was in the 18th and 19th centuries. At that time, the mortality rate rose rapidly. With the introduction of anesthesia and antisepsis of the modern brain surgery began. In modern neurosurgery, the trepanation a standard procedure with a relatively short duration of surgery (often less than one hour) dar. About the skull hole can be inserted catheters and drains, eg for relief of a space-occupying hematoma or fluid drainage for drainage of cerebrospinal fluid ( CSF ) with increased intracranial pressure.

Trepanation among the Kisii (East Africa)

The first written records of the East African trepanation come from British and German officials and doctors end of the 19th century. In Europe, trepanation was known until around 1957, when British doctors photographed successful Schädeltrepanationen and published. You could make between 20 and 35 medicine men find that even first names skull openings. For the first time a trepanation was filmed by the Austrian Max Lersch 1958, which also was confirmed that no drugs were used. 1979 was one of the German doctor Rolf Meschig only six Schädelöffner. Today in Kenya Schädeltrepanationen are officially prohibited without doctor's supervision.