By Dr. Kaviyarasu MD, MedCardia Research Team

 

What Is Trepanation?

Trepanation (also known as trephination) is the ancient surgical practice of drilling or scraping a hole into the human skull. It is considered the earliest form of neurosurgery, dating back more than 8,000 years. Prehistoric cultures used tools like flint, obsidian, and early metal instruments to create precise openings in the skull, often without killing the patient.

Why Did Ancient People Perform Trepanation?

Medical Reasons

Trepanation may have been performed to relieve pressure from skull fractures, brain swelling, or traumatic injuries. Some scholars believe it was used to treat epilepsy, seizures, and mental illness by releasing “spirits” believed to be trapped inside the head.

Spiritual and Ritual Beliefs

In many prehistoric societies, trepanation had a spiritual dimension. It was believed to release evil forces or induce visions. Some ancient cultures, such as the Inca civilization, used ritual trepanation as part of religious ceremonies or initiation rites.

Trepanation Across Cultures

Evidence of trepanation has been found in regions around the world—including Europe, Africa, Mesoamerica, and especially Peru. Archaeologists have uncovered over 10,000 trepanned skulls in Peru alone. Some skulls have holes as small as a few centimeters, while others show openings covering nearly half the cranium.

In the Middle Ages, trepanation was revived in Europe to treat skull fractures and seizures. One of the earliest detailed surgical descriptions comes from the Islamic physician Albucasis (936–1013 AD), who documented the use of drills and emphasized avoiding damage to the brain’s outer membrane.

How Did They Do Surgery Without Anesthesia?

Ancient people likely used primitive anesthetics such as coca leaves, alcohol, or herbal sedatives. In some cultures, hypnotic trances or ritual chants may have been part of the process to reduce pain. Despite the lack of modern equipment, many patients survived, as shown by skulls with significant healing around the edges of the drilled area.

Trepanation in Modern Times

Trepanation is no longer practiced in traditional form. However, a modern neurosurgical technique known as craniotomy involves removing a part of the skull to access the brain—similar in principle but performed under sterile conditions with anesthesia. Some fringe individuals in recent history have attempted self-trepanation, falsely believing it can enhance consciousness or mental clarity. These practices are dangerous and medically unsupported.