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By using our site, you agree to our collection of information through the use of cookies. To learn more, view our Privacy Policy. To browse Academia. We report a case study of cranial trepanation in a male subject 30 to 40 years of age from the Nefteprovod II burial ground in the Anzhevsk archeological site. The left parietal bone had an opening with evident signs of bone healing, as well as signs of inflamma-tory reaction from both bone plates of the calvarium. The strongest signs of inflammation were located around the trepanation opening at the exocranium, suggesting that it occurred after, rather than before, the operation. Although trepanation was the main cause for the development of the changes noted in the preceding texts, there are no reasons to believe that the subject died from complications arising from infection after trepana-tion. The patient survived and later died for reasons that may never be determined. Medical necessity was the most likely justification for trepanation. Immersion in altered states of consciousness may also have been a necessary part of the trepanation process as a mode of sedation, along with other shamanic practices, such as consumption of psychotropic substances or ecstatic dance. These data, together with reports of other ante mortem burials, raised questions about the application of anaesthesia and possible techniques of cranial trepanation. These issues and possible postoperative complications are discussed in the following text. Surgical-therapeutic attempts may be apparent by the presence of fractures, however, ritual or nonmedical motives are rarely supported by visible evidence in the bones. This article presents data on the trepanations of several individuals from South Russia dating to the Eneolitic and Bronze Age that may indicate a ritual procedure. In these crania an operation was performed in the identical location, the midline, furthermore in one of the most dangerous places, on the obelion. No evidence for traumatic or other pathological reasons for performing the operations was observable. Material and Methods Investigations of two nearby areas of South Russia revealed 13 individuals showing complete perforations in the midline of the cranium. Another one, displaying a depression in the same place, primarily diagnosed as an incomplete trepanation, is discussed considering all differential diagnoses. The trepanations were investigated macroscopically, by plain radiography and computed tomography. The lesions were described in detail, including data on technique, position, size, shape, state of healing, and complications. Only grooving and scraping techniques were used and their application differed between sexes. The majority of the patients survived the intervention for a long time. Discussion The region of Southern Russia seems to be a center for special trepanations performed by skilled surgeons, the specific position of the perforations implying more a ritual than therapeutic reason for trepanning. Am J Phys Anthropol, According to the classification of trepanations used by modern palaeopathologists, one group includes ritual operations. In prehistoric Europe trepanations post-mortem was accomplished to create amulets from the bones of human skulls, while in Central Asia post-mortem operations were connected within funerary traditions, including embalming and mummification. From 4 series, numbering 88 skulls, 9 trepanned skulls were recognized in which this procedure was performed on crania before the soft tissue had disappeared. Lesions, classified according to location and size, revealed five basic types. Materials and methods. In , the archeological excavation at mound No. According to the dig author, the buried woman came out of the well-off section of the Sarmatian confederation. The accompanying items in the burial are quite expressive and includes a weapon of war a tip of a spear and, at the same time, a set of some objects beads, shells, pendants made of ceramics fragments, chalk and bronze , which, indeed, allows to make an assumption that the woman also performed hieratic functions. The description of the defects fixed on the cranium from the Verbovsky burial ground was made with the use of recommendations suggested in the works by M. Mednikova , A computerized tomography scan method was used during the differential diagnostic procedure. Scanning was made by Siemens Somatom Definition slice computed tomography scanner with two X-ray tubes. The perforation examination let state that the defects are burr holes created by drilling. The absence of healing marks displays antemortem or postmortem character of operations. Previous studies of the problems and reasons of widespread postmortem trepanation performed by the Eurasian ancients have been analyzed. It allowed us to determine that the performing type of trepanation of the cranium from Verbovsky I burial ground has some analogies with the middle and late Sarmatian burials in the Lower Volga river region, and also in the memorials of the Western and Central Kazakhstan of the V—III centuries B. The operations on the cranium of the woman found in the Verbovsky burial are of ritual and symbolic importance. However, it is quite difficult to determine the type of a ritual or tradition which laid as the background for these artificial manipulations with a human cranium. The remains were examined with standard macromorphological methods of bioarcheology. The most presumable diagnosis of the lesions is surgical trephination. In this note, we discuss a case of cranial trepanation that originated from a catacomb burial discovered in the Mingachevir area of Azerbaijan. The catacomb burials on the territory of Azerbaijan date back to the 1st-7th centuries AD. The studied skull comes from an old adult male senilis category , is brachycranic and relates to the southern branch of the Caucasian phenotype — Caucasian Albanian. This man probably was a representative of the local Caucasoid population. An oval-shaped trepanation was identified on the left parietal bone, measuring 0. Homo — Journal of Comparative Human Biology, In this study, trepanations in ancient Armenia are discussed. In total, 10 cases were studied. Seven were male, 1 female and 2 were children. Age of the individuals ranged from 6 to 65years. Among nine cases of surgical trepanations four had possible healing signs. In thesecases the individuals showed evidence of previous trauma to the skull or infection mas-toiditis, tuberculosis , suggesting that the operation had been carried out for therapeuticpurposes. This provides further support for the suggestion that trepanation or trephina-tion was performed primarily for therapeutic purposes, and because of cranial infectionor injury. In one case, a symbolic trepanation could imitate real penetration into the skullcavity. This study shows that archaeological sites of Armenia and anthropological materialshave a potential to supply essential information on ancient history of the Armenian peopleand the region. This article aims to introduce readers to the world of trepanned skulls, specifically focusing on cases from the Iron Age. This is a fascinating and intriguing topic for various fields. We will begin by defining cranial trepanation and then briefly present the origin, antiquity, and spread of this intervention, as along with the typology proposed by specialists. We will explore step by step the stages and methods of performing cranial trepanation, to also present some tools believed to have been used as trepans during the Iron Age, but also the survival prospects of an individual who was subjected to cranial trepanation. Once these particularities are known, we will proceed to a brief description of Iron Age trepanations discovered thus far in the Circum-Carpathian region, but we will also refer to other discoveries from the Eurasian area. We conclude with an excursus into the current state of intentional cranial interventions discovered in the Republic of Moldova. Archaeology, Ethnology and Anthropology of Eurasia Russian-language , Such openings were found in two male specimens of the Sauromato-Sarmatian age from Bykovo burial 4, kurgan 13 and Baranovka burial 2, kurgan Using macroscopic and X-ray examination, we attempt to identify the surgical techniques and the reasons behind the operations. The cranial vault of the Bykovo individual was trepanned by scraping and cutting, for medical purposes. The man survived the surgery, as evidenced by healing. In the case of Baranovka, the operation was performed postmortem or peri-mortem by drilling and cutting, possibly for ritual purposes. Collating these cases with others relating to the Early Iron Age nomadic Sauromato-Sarmatian culture of the Lower Volga region and adjacent territories and with written and archaeological sources suggests that the closest parallels come from Central Asia, and Southern and Western Siberia, where the custom of post-mortem ritual trepanations was very common. Testing is part of learning, that enables students to show what they know, while enable teachers to evaluate their work and the areas where it exists need for improvement. Revista de Inteligencia Artificial en Medicina, Log in with Facebook Log in with Google. Remember me on this computer. Enter the email address you signed up with and we'll email you a reset link. Need an account? Click here to sign up. Related papers New cases of trepanations from the 5th to 3rd millennia BC in Southern Russia in the context of previous research: Possible evidence for a ritually motivated tradition of cranial surgery? Anahit Khudaverdyan. Note about one case of cranial trepanation from catacomb burial of Mingachevir Azerbaijan Republic Dmitriy Kirichenko. Causations and methods of the skull trepanation in the past from the point of view of the latest findings from the Czech territory. Anthropologie Hana Brzobohata. On cranial trepanation. A special look at some cases from the Iron Age Angela Simalcsik. International Journal of Osteoarchaeology Int. Although trepanation was the main cause for the development of the changes noted in the preceding texts, there are no reasons to believe that the subject died from complications arising from infection after trepanation. Key words: trepanation; Late Bronze Age; Karasuk culture; paleopathology; complications; anaesthesia; shamanic practice Introduction Investigation of the closely located Nefteprovod I and Nefteprovod II burial grounds was a very important target of rescue archaeological work performed at the Anzhevsk archeological site. This site is located near the former Anzhevka settlement on the right bank of the Kan River, southeast of Kansk, in the Krasnoyarsk region Figure 1. During excavations, we found 15 burials. Some burials were covered by one layer of stones. Positioned straight on their backs, the subjects were oriented eastward towards the Kan River. Several burials contained ornaments, as well as metal, bone and stone tools. Materials and methods The trepanned skull, which served as the material for further analysis, was discovered in burial 2 m, a pit with a blurred and complicated shape, 1. Burial 2 m was pillaged by robbers in ancient times. Only the position of the skull remained unchanged. The postcranial skeleton had fragments of tubular bones of the upper limbs and fragments of ribs. These bones were poorly preserved and could not be used to determine sex and age. Apart from the subject, an integral crank knife and two stone arrowheads were found in burial 2 m. The discovered objects have no direct analogies. Slepchenko et al. Figure 1. The black point marked the place of Nefteprovod II burial ground in the Anzhevsk archeological site. Late Bronze Age found in the middle Yenisei. Cultural and chronological interpretations suggest that the burials belong to the Karasuk culture of late to the early BC Vybornov et al. Sex determination was carried out using standard anthropological methods. The trepanation opening was described according to the recommendations of M. Mednikova in her monograph Mednikova, Upon analysis of the previously noted characteristics of the opening, we determined a trepanation technique according to the chart developed by F. Skull description in the context of trepanation The skull from burial 2 m had well-preserved fragments of the calvarium mandibula and maxilla. Facial bones and bones of the skull base were partially destroyed. According to the morphological characteristics, the cranium belonged to a man. The extent of external suture obliteration and tooth attrition suggest that the age at death corresponded to 30—40 years. The left parietal bone had an irregular oblong opening located 25 mm away from the sagittal suture to the left and 45 mm away from the coronal suture posteriorly. Obliteration of the diploe on the internal and external surface of the calvarium suggests that the healing lasted for some period of time, more than 3 months Anda, ; Nerlich et al. The edges of the trepanation opening were unevenly inclined towards the calvarium. The side edges of the trepanation opening were inclined almost vertically. However, the front and rear edges had a smoother slope, with the slightest inclination of the opening at the front. The hole measured 42 by 26 mm on the outer table and 30 by 16 mm on the inner table of the skull. The anterolateral trepanation area had a damaged bone fragment 15 mm in length, making the hole irregular. Hyperostosis and periostitis were present in the exocranium around the anterior and posterior trepanation area Figure 2. The anterior—posterior trepanation area largely extended to and overlapped the front and rear parts of the left parietal bone and the area near the sagittal suture of the right parietal bone. Finally, portions of newly formed bone tissue were observed on the inner table around the opening, both anteriorly and posteriorly. The dorsolateral border of the trepanation opening was 8—10 mm from the parietal branch of the middle meningeal artery Figure 3. Moreover, Int. A close-up of the side of the left parietal bone with the trepanation opening. The arrows indicate the periosteal reaction at the cranium. Bone formation on the endocranial surface of the left parietal bone in the area of the parietal branch of the middle meningeal artery. Discussion In human history, cranial trepanation is one of the earliest operations performed in different parts of the world Brothwell, ; Arnott et al. Figure 4. Bone formation on the endocranial surface of the frontal bone in the area of the frontal branch of the middle meningeal artery. Among the few records of ante mortem trepanation practices in the territory of Siberia, some cases can be associated with the Neolithic and the Bronze Age. For instance, a trepanned female skull found in the Botai settlement of northern Kazakhstan gives evidence of trepanation in Western Siberia during the Neolithic Age — years BC. This female cranium had two openings between the parietal bones along the sagittal suture. According to G. Rykushina, the individual underwent trepanation while still alive. Five trepanned skulls were found during excavations of the Sopka II burial ground, as representative of the Igrekovskaya culture. These scientists suggest cranial injury as the most likely reason for trepanation because the cranium was fractured on the outer table of the left parietal bone and showed subsequent infectious complications with necrosis in the cranial bones. Under these circumstances, a surgical intervention could have been performed. The other four cases of trepanation by drilling have no signs of bone remodelling and were Int. The skull of a woman 25 to 30 years of age found in the burial ground at Mount Khara-Kha Askizsky region, Khakassia provides evidence of trepanation among the Late Bronze Age Karasuk population in southern Siberia. The healing of the bone tissue occurred unevenly in the trepanation area, suggesting that the operations were performed at different times. Trepanning was performed by scraping and incisions. The trepanation openings were mostly located on the left parietal bone. The initial intervention occurred in the parieto-occipital region and then extended to the left parietal bone forward and backward. In addition, signs of local osteophytosis and a slight porotic alteration of the adjacent portions indicate an infection in the trepanation area Mednikova, Taken together, these data give further support to ante mortem trepanning in Siberia during the Late Bronze Age, among them the study subject from burial 2 m. Use of anaesthesia Trepanation opening with evident signs of healing suggests successful early surgery in eastern Siberia during ancient times. No direct evidence suggests that drugs were used to minimize pain during operations performed in preliterate eras. Such records and ethnographic materials cannot be inferred to draw direct parallels to actual practices but, instead, only serve as an example of changing attitudes and practices in the use of anaesthetics in ancient times. Although plants serving this purpose are largely absent in Siberia, a few plants causing altered states of consciousness were applied in shamanic practices. For instance, the Nivkhi would burn wild rosemary Ledum palustrel, Ledum hypoleucum sticks and leaves for their rituals Otaina, Some people of Siberia used juniper Juniperus sibirica and thyme Thymus vulgaris in shamanic practices for the same purpose Otaina, It is well known that the Scythians consumed cannabis Herodotus, ; Pashkevich, Strong evidence suggests the consumption of cannabis in the Pazyryk culture in south Siberia Rudenko, Many people of northeastern Siberia are famous for consuming these fungi to alter consciousness Georgi, ; Diachkov, ; Elistratov, ; Yokhelson, ; Krasheninnikov, ; Maidel, Again, we can only speculate that the consumption of fungi, together with other shamanic practices, such as ecstatic dancing or the use of a drum, was a likely method of altering the conscious state of a patient and thus reducing pain to the extent necessary to carry out surgery. This would suggest that the practice of trepanation for therapeutic purposes was closely bound with ritualism. Macroscopic characteristics of the trepanation opening, including an oblong shape, almost vertical inclination of the side edges of the opening, a smoother slope of the front edge and a more vertical slope of the rear edge, all suggest scraping. Indeed, according to some authors, scraping was the earliest technique of trepanation and was practiced in different parts of the world Lisowski, ; Prioreschi, ; Piek Int. The trepanned skull found in burial 2 m gives evidence that the scraping method was used in early times in Siberia. While we cannot completely reconstruct the surgical procedure, we can use the observations at our disposal to build a model to suggest trepanation of the subject found in burial 2 m. These two indispensable conditions were crucial in ancient times as they are now. Then, for the preparatory phase of the operation, we can only use our best guess. However, based on the shape and type of inclination of the edges, we may infer that the patient lay in the supine position with the head turned to the right. The surgeon probably stood face to face with the patient at the left side of the patient. According to M. Mednikova, the left-sided localization of the opening was a common cultural tradition Mednikova, Trepanning is known to be a very old healing method for cranial fractures. The surgeon probably had an assistant. During the operation, the assistant might have also passed instruments and other materials. Skin and aponeurosis were peeled off the underlying bone. The next phase was bone scraping. Changes in bone as a result of healing prevent us from guessing what instrument was used for trepanning or how it was made. Some authors believe that scraping tools were made of different materials, such as rock, metal, bone and even wood Margetts, ; Gross, ; Watters, We learn about ancient medical instruments mostly from written sources that are rarely found at archaeological sites. Nevertheless, some sort of medical instruments existed in Siberia and were broadly used for postmortem manipulations. These same instruments may have been applied for trepanation. Scraping lasted until dura mater was exposed after which the trepanation area could be enlarged broadwise, but never below. Penetration of dura mater causes the development of intracranial hematomas because of bleeding between the meninges. Subsequent complications, such as wound abscess, meningitis and brain abscess, lead to death. The fact that individuals, including the subject in burial 2 m, lived for some period of time after the trepanation suggests that the dura mater remained intact long enough for strong signs of healing to appear. The opening was covered with skin after trepanation. However, the wound could not be too tight in order to allow serosanguinous exudate and the resulting minimization of infection. Nonetheless, some ethnographic records give evidence that these simple devices were implemented during trepanation Watters, Intraoperative and postoperative complications One of the most probable and most dangerous intraoperative complications of trepanation is bleeding that develops immediately after the skin incision. As a Int. To minimize bleeding and reduce pain, the operation had to be carried out as fast as possible by a presumably highly skilled surgeon. Finally, we are not aware of the methods used by ancient surgeons to stop bleeding. They might have applied herbs, or red-hot objects, or hot solutions. However, the application of these agents and methods cannot be excluded. Wound infection and purulent complications are one of the most severe postoperative complications in contemporary neurosurgery and were likely the most serious ones in ancient times Erman et al. Ancient doctors were aware of the danger of developing wound abscess Hanson, Although trepanation was the main cause for the development of the changes noted in the preceding texts, we have no reasons to believe that the subject died from complications of infection. Reasons for trepanation Cranial trepanation was carried out for therapeutic or ritualistic reasons. Therapeutic trepanations were carried out to alleviate disease or treat illness and injury. On the other hand, ritualistic trepanations were also performed. Therefore, we may only speculate about the intended purpose of the trepanation performed on the subject of burial 2 m. It also seems unlikely that cranial trepanation was carried out to make an amulet because the main technique of this trepanation was scraping, as revealed by the present study Gresky et al. Moreover, scraping would never have been used to make an amulet. Instead, enthlasis, either open or closed, may have been the reason for this trepanation. However, it would have been senseless to remove bone fragments by scraping. The shape of the opening with nearly vertical side edges and smoother front and rear edges suggests that the trepanation opening was not scraped in order to smooth sharp edges. Most studies suggest that ancient surgeons were able to perform complex interventions and care for the patient during the postoperative period. In other cases, cultural Int. While studying the skull bones of the subject from burial 2 m, we found no signs of disease that could have been the medical reason for trepanation, but at the same time, we cannot deny the presence of medical indications for it. We agree with M. Mednikova Mednikova, who suggests in her monograph that close intertwinement of medical indications with ritualistic and symbolic activities commonly resulted in cranial trepanation. Immersion in altered states of consciousness may have been a necessary part of the process of trepanation, for example, sedation, along with shamanic practices, such as consumption of psychotropic substances or ecstatic dance. The fact that this case of trepanation was successfully performed ante mortem gives further evidence that ancient peoples had the necessary skills. Thus, the patient survived and later died for reasons we may never determine. References Anda T. Acta archaeologica Academiae Scientiarum Hungaricae 1: 7— Prehistoric trepanation in the Cuzco region of Peru: a view into an ancient Andean practice. American Journal of Physical Anthropology 1 : 4— The origins of horseback riding. Trepanation: History, Discovery Theory. The Cambridge Encyclopedia of Human Paleopathology. Cambridge University Press: Cambridge. Bartucz L. Adatok a koronyalekeles trepanacio es a bregmasebek kapcsolatanak problemajahoz magyarorszagi nepvandorlaskori koronyak alapjan, in Annales biologicae universitatis Szegediensis. Tomus I. Redigit A. Abraham: Szeged; — After death trepanation in elite burials Saka era in Central Kazakhstan. The News of Altai State University 84 : 31— Bliquez LJ, Jackson R. Verlag Philipp von Zabern: Mainz. Ethnopharmacological study of some psychoactive drugs of small peoples of Siberia and the Far East. Medicines of the Far East. Khabarovsk 16— Brothwell D. Digging Up Bones. Trustees of the British Museum: London. 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The Population of Ukraine in the Mesolithic and Neolithic. Science: Moscow. Hodder I. The Histories, Translated by Aubery de Selincourt. Penguin Classics: New York. Epidemics V. Hippocrates Vol. VII Transl. Harvard University Press: Cambridge, Massachusetts. Jenker FL. Prahistorische und pracolumbianische Schadeltrepanationen. Kultisch-theurgische oder rationellmedizinische Handlung?. Paracelsius-Schriftenreihe der Stadt Villach. Geleitet v. Symbolic trepanation of skulls from the middle ages IXth—Xth century in Bulgaria. Acta Neurochirurgica 15— Koschel K. Opium alkaloids in a Cypriote base ring I vessel bilbil of the middle bronze age from Egypt. Agypten und Levante 6: — Krasheninnikov SP. Leningrad: Glavsevmorputi. Kunzl E. Lastres JB, Cabieses F. Universidade Nacional de Cuzco: Lima. Lindensmith AR. Addiction and Opiates. Aldine Transaction. New Brunswick: New York. Lindenau JI. Magadan publishing house: Magadan. 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Publisher Institute of Archaeology and: Ethnography in Novosibirsk. Trephined skulls from the tenth century. Acta Archaeologica Academiae Scientiarum Hungaricae. XVII: — The pathology of trepanation: Differential diagnosis, healing and dry bone appearance in modern cases. Trepanation History, Discovery, Theory 43— Otaina GA. Ethnicity and culture. Dalnauka: Vladivostok. Pashkevich G. New evidence for plant exploitation by the Scythian tribes during the early Iron Age in the Ukraine. Acta Palaeobotanica Supply 2: — Stone Age skull surgery in Mecklenburg-Vormommern: a systematic study. Podmaskin VV. Use of medicinal plants and animals Udege people. Prioreschi P. Possible reasons for Neolithic skull trephining. Perspectives In Biological Medicine — Rifkinson-Mann S. Cranial surgery in ancient Peru. University Chelyabinsk: Chelyabinsk. Rytel MM. Trephinations in ancient Peru. Bulletin Of Polish Medical Science 5: Rudenko SI. Frozen Tombs of Siberia. Dent: London. Saleem SN, Hawass Z. American Journal of Roentgenology 4 : — Schulz M, Kozak AD. Opus: Interdisciplinary Research In Archeology 6: — To the question of medical knowledge of early medieval population Tobol based on burial Ustyug 1. Sobre las trepanaciones craneanas en el Antiguo Peru. Revista Neuropsiquiatria — Tung TA. American Journal of Physical Anthropology 3 : — Rescue archaeological excavations at the location Rjabchikov key—one near the city of Kansk in Verano J. Trepanation in prehistoric South America: geographic and temporal trends over years. Watters DAK. Skull trepanation in the Bismarck Archipelago. Papua New Guinea Medical Journal 50 1—2 : 20— Weber J, Wahl J. Neurosurgical aspects of trepanations from Neolithic times. International Journal of Osteoarchaeology — Weber J, Czarnetzki A. Neurotraumatological aspects of head injuries resulting from sharp and blunt force in the early medieval period of southwestern Germany. American Journal of Physical Anthropology — Yokhelson VI. Koryak: Material Culture and Social Organization. Science: St. A year-old hand amputation from Bulgaria—the oldest case from south-east Europe? Annotazioni sulla prassi dell' ornamentazione cembalo-organistica nel Barocco Lorenzo Ghielmi. Semenenko A. Web Gnomonices N. Physicochemical characterization, carotenoid content and protein digestibility of pumpkin access flours for food application Fernanda Doring Krumreich. Preconditioning during coronary angioplasty: no influence of collateral perfusion or the size of the area at risk laurence bontemps , L. Fast responsive, optical trace level ammonia sensor for environmental monitoring Torsten Mayr. Environmentally-triggered contraction of the norovirus virion determines diarrheagenic potential Dhairya Shah. Dynamic behavior and modal control of beams under moving mass Mohammad Reza Shadnam.

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