Trephination: Putting a hole on your head

Fig. 1: The Extraction of the Stone of Madness by Hieronymus Bosch del Prado. (Google image)

On August 23, 2010, a Hong Kong tour bus was being hijacked by a former Philippine police inspector, Mendoza in Manila. Mendoza claimed that he was dismissed from his job unjustly, and demanded a hearing for himself. Yet, the negotiation went downhill. He opened fire when he was acknowledged that the police had arrested his brother. Nine people on the bus, including Mendoza himself, were killed and some on the bus were severely injured. Among the injured, there was one young man from Hong Kong suffered from severe hematoma, and was sent back to Hong Kong for urgent treatment, namely trephination.

What sort of surgical treatment is trephination?

Trephination “is the oldest documented surgical procedure performed by man.” (Faria 2013) It basically is to drill a hole on a relatively safe spot on the skull to release the pressure inside the cranium, which possibly developed from hematoma. Though it is purely a medical trauma treatment today, trephination was also considered as a “magical”, religious and ritual treatment. Without a doubt, even with advanced medical techniques and knowledge today, “successful implementation of trepanation (Trephination) requires the serious knowledge and training and the procedure itself is not considered as absolutely harmless.” (Russon 2014)

Trephined skulls (i.e. skulls with a hole) are able to be found from the Old World of Europe and Asia, and also the New World, particularly Peru and South America. As above mentioned that trephination is such a high risk treatment, yet archeological findings from the pre-Inca, Peruvian civilization show the treatment of trephination and amazingly many of the treated patients of the prehistoric times survived from the surgery at least for a while, which supported by the bone healing and growth at the edges of drilled holes (Faria 2013). No scientific evidences to support any clinical symptoms improved after all of those prehistoric operations.

Yet, trephination back then was also used as a treatment for epilepsy, headache and various diseases that linked with demons. They believed that by making a hole on the scalp of one’s head would give the demons or the evil possessed a way to escape. In ancient Greece and Rome, instruments for trephination are also developed, which according to Faria, it set forth the engineering of the manual burr hole and electric drill neurosurgeons use for today’s craniotomy procedures. Later on in Renaissance, shape of the trephines had been modified. [Fig 1.]

Interestingly, scientists and anthropologists found that the trephination surgeries made by the Pazyryk surgeon in Siberia followed a strict recommended protocol of the Hippocratic Corpus from ancient Greek, which is believed that have been sat down around 5000 kilometers away (Liesowska 2014). The technique may varied but the care for the patient and the placing of the trephined hole show a similar ethical aim, according to Liesowska.

Then in 19th century, adapted from the past historic meaning, trephination is used in hospitals for mentally ill patients, as surgeons believed that the surgery would change the abnormal behaviors of patients, which in turns make institutions overcrowded. This view was celebrated after observing the famous American Crowbar Case in 1848. A construction foreman got severely injured while helping construct a railway line in 1848. A long bar measuring 3 feet 7 inches in length and 1.25 inch in diameter through Gage’s head. The 13.25 pound rod penetrated his left cheek, and exited the cranium just right of the midline near the intersection of the sagittal and coronal sutures [Fig 2.]. Gage survived but experienced a complete personality change—from being a responsible and energetic person to socially uninhibited individual.

 Fig. 2: American Crowbar Case (wikicommon)

The relationship between behavior change and the surgery is still understudy, especially the meaning of trephination carried out before prehistoric era, given that it may not related to any treatment of any kinds of diseases.

Trephination in a glance:

Ask Smithsonian: Do People Really Drill Holes in Their Heads? [Video]


Faria MA. Violence, Mental Illness, and the Brain- A Brief History of Psychosurgery: Part 1- From Trephination to Lobotomy. Surg Neurol Int. 2013:4-49.

Manila Hostage Crisis.

Liesowska, Anna.  17 September 2014. Scientists to recreate 2,300 Year Old Brain Surgery After Finding Evidence of Successful Operations. The Siberian Times.

Russon, Mary-Ann. 17 September 2014. Successful 2,300-Year-Old Brain Surgery Techniques Now Being Recreated in Siberia. International Business Times.