Trepanation

The act of surgically cutting a round hole.

Definition

Trepanation is a surgical procedure in which a circular piece of bone is removed from the skull by a special saw-like instrument called a trephine or trepan. The operation is also known as trephination or trephining. The English word "trepan" comes from the Greek word trypanon, which means "auger" or "drill."

In standard medical practice, trepanation is occasionally performed by a neurosurgeon in order to relieve pressure on the brain caused by trauma, or to remove a blood clot from brain tissue. In recent years, however, trepanation has been touted by a small group of alternative practitioners as a way to expand one's consciousness through the increase of blood flow to the brain and opening the "third eye," also known as the inner eye or eye of the mind. Practitioners of kundalini yoga refer to the opening of the third eye, located in the middle of the forehead, as entry into a new and completely different dimension of reality.

Origins

Trepanation is the oldest surgical procedure known to humans; skulls of Cro-Magnon people estimated to be 40,000 years old have been discovered with circular holes as large as 2 in in diameter. The Incas of Peru are known to have performed trepanation as early as 2000 B.C. It is thought that these operations were performed to treat people suffering from psychotic disorders, epilepsy, or chronic migraine headaches by allowing demons to escape through the hole in the skull.

The oldest written reference to trepanation comes from Hippocrates (c. 400 B.C.), whose descriptions of head injuries refer to it as a necessary treatment for skull fractures with bone fragments pushed inward and compressing the brain. Celsus and Galen refer to Roman surgeons of the first century A.D. as performing trepanations with implements resembling carpenters' drills. Trephines were refined in various ways through the Middle Ages, the Renaissance, and the eighteenth and nineteenth centuries. It should be emphasized that trepanations were done by ancient, medieval, and early modern physicians to relieve pressure on brain tissue—not to perform surgery on the brain itself. Care was taken not to penetrate the dura mater, which is the outermost of the three meninges or membranes that lie beneath the skull and form a protective cover for the brain and spinal cord. Historians of medicine estimate, however, that as many as 40 percent of patients died from infections following the procedure rather than from the surgery itself.

Contemporary interest in trepanation as a path to expanded consciousness goes back only to the 1960s. Bart Huges, a Dutchman who was expelled from medical school in the early 1960s for failing his examinations and using marijuana, is generally considered the founder of alternative trepanation. Huges developed a theory that he called brainbloodvolume while he was smoking marijuana at a party on the island of Ibiza. He noticed another guest standing on his head to increase the intoxicating effects of the drug. Huges concluded that the expansion of consciousness associated with hallucinogens results from an increased volume of blood in the brain. He reasoned that the removal of a piece of the skull would allow an even larger amount of blood to enter the brain, speeding up the delivery of oxygen and glucose to the brain cells as well as the removal of toxins. Huges had also learned in medical school that infants are born with soft spots in the skull known as fontanelles, which are membrane-covered areas where the bone has not yet completely formed. He concluded that trepanation would help to return an adult's consciousness to the intense imagination and vivid dreams of a child.

Huges—who never obtained a medical degree—managed to convert several individuals to his brainbloodvolume theory—among them Peter Halvorson, who underwent trepanation and credits it with curing hisdepression, increasing his energy level, and giving him a permanent drug-free high. As of 2004, Halvorson is the head of the International Trepanation Advocacy Group (ITAG), headquartered in Wernersville, Pennsylvania. The ITAG web site includes accounts of a pilot study of six volunteers who were trepanned in June 2002 as well as personal testimonials from others who have undergone the procedure.

Benefits

According to the testimonials collected by Halvorson, trepanation confers the following benefits:

• relief from anxiety, depression, and other mood disorders
• feelings of freedom and serenity
• a richer emotional life
• greater ability to recall dreams on awaking
• decrease in frequency and severity of chronic headaches
• higher energy levels

Other people who have undergone trepanation, however, maintain that these benefits are only temporary and may be due to the placebo effect. A man who performed trepanation on himself in 2000 reported to an interviewer from an online body modification journal that he had "come to the frustrating conclusion [four weeks after the procedure] that the trepanation has had no lasting effect… Trepanation has no more physiological effect than any other trauma… it does not do what many hope it will."

Description

Surgical Trepanation

A standard trepanation—most commonly done to relieve pressure on the brain when a portion of the skull has been pushed inward—is performed with the patient under general anesthesia under sterile conditions. The neurosurgeon cuts the scalp over the injured area, pulls back a flap of skin, and bores a hole in the underlying skull with a trephine. After the depressed bone has been removed together with any blood clots that have formed, the surgeon carefully cleanses the area and closes the incision.

Alternative Trepanation

Some alternative trepanations have been performed by people on themselves, with friends to assist with the procedure. In the early 1980s, several people in England performed the entire operation on themselves, with others present to help only if an emergency arose. The reason for this stipulation was to protect the others in the room from criminal prosecution for performing surgery without credentials. The trepanner typically shaved his or her head and injected a local anesthetic. He or she then made an incision in the scalp over the area to be trepanned. Next, a hole between 1/4 and 1/2 in in diameter was cut in the skull with a foot-powered dental drill. The trepanner then removed the piece of skull, cleaned the incision, and bandaged it. The scalp gradually grew back over the hole, leaving only a small permanent indentation. More recently, however, trepanners have allowed others to assist with the operation; the man who was interviewed for the online journal had three friends who covered the walls of his room with plastic sheeting, did part of the drilling, and rinsed out the incision from time to time with sterile saline solution. He reported that the entire procedure took about 3-1/2 hours.

The participants in the ITAG pilot study, however, went to a clinic in Monterrey, Mexico, for their trepanations. The ITAG web site states plainly that "Self-trepanation today is a very selfish act. It opens the door for no one and you'd always have to keep it a secret. The public mind can't handle this. You'd be labeled 'insane.'" According to the ITAG web site, the surgeon who presently performs the procedures for Halvorson's groups was trained in Texas and is board-certified in four countries (France, Spain, Mexico, and the United States). The trepanations take about 35 minutes to complete. The cost of the operation is $2400–$3600, not including travel and hotel fees.

Preparations

People who have performed trepanations on themselves have prepared by assembling the needed equipment and setting aside a room in their house to serve as the operating room.

ITAG requires persons interested in trepanation (who must be 18 or older) to go through a period of mental preparation known as engramming, which Halvorson defines idiosyncratically as "becom[ing] thoroughly acquainted with the terminology of conscious expansion." In addition, the volunteers must sign an informed consent form and a protocol that indicates that they understand the procedure is considered experimental. They are given MRIs before and after the trepanation.

Precautions

Mainstream medical professionals uniformly warn against alternative trepanation because it is an extremely risky procedure—particularly if done by amateurs—with no certain or permanent benefits. Because scalp incisions bleed profusely, people who attempt to trepan themselves are likely to find that the flow of blood obscures their field of vision, thus increasing the risk of self-injury.

Side Effects

The potential side effects of alternative trepanation are severe, even life-threatening; they include permanent injury or death from infections, stroke, direct damage to brain tissue, generalized encephalitis, epilepsy, or brain abscesses.

Research & General Acceptance

Trepanation is not accepted as an alternative therapy by any mainstream physicians or surgeons in the United States or Canada. In addition to the dangers of the procedure itself, neurosurgeons who have studied the claims made for trepanation say that Huges' brainbloodvolume theory is anatomically impossible.

Training & Certification

As of 2004, there are no reputable medical school courses, training institutions, or licensing procedures in the United States or Canada for trepanation performed as a means to altered or higher consciousness.

Resources

Books

Michell, John. Eccentric Lives and Peculiar Notions. Secaucus, NJ: Citadel Press, 1984.

Periodicals

Clower, W. T., and S. Finger. "Discovering Trepanation: The Contribution of Paul Broca." Neurosurgery 49 (December 2001): 1417–1425.

Facchini, F., E. Rastelli, L. Ferrero, and E. Fulcheri. "Cranial Trepanation in Two Skulls of Early Medieval Italy." Homo 53 (2003): 247–254.

Van Alphen, H. A. "Elective Trepanation for Acute Epidural Hematoma by Dr. Nicolaes Tulp (1593–1674)." Neurosurgery 48 (February 2001): 401–404.

Weber, J., and A. Czarnetzki. "Trepanations from the Early Medieval Period of Southwestern Germany—Indications, Complications and Outcome." Zentralblatt für Neurochirurgie 62 (February 2001): 10–14.

Organizations

American Association of Neurological Surgeons (AANS). 5550 Meadowbrook Drive, Rolling Meadows, IL 60008. (888) 566-AANS or (847) 378-0500. Fax: (847) 378-0600. .

International Trepanation Advocacy Group (ITAG), Inc. P. O. Box 65, Wernersville, PA 19565. (610) 693-6869. Fax: (610) 693-3261. .

Other

Henderson, Bryan. "Trepanation." Interview conducted for Body Modification Ezine (BME). .

[Article by: Rebecca J. Frey, PhD]

For other uses, see Trepanation (disambiguation).

"Trepan" redirects here. For the tool, see Drill_bit#Trepan. For the record label, see Trepan Records. For the seafood, see Trepang.

This article needs reorganization to meet Wikipedia's quality standards. There is good information here, but it is poorly organized; editors are encouraged to be bold and make changes to the overall structure to improve this article.

18th century French illustration of trepanation

Trepanation (also known as trepanning, trephination, trephining or making a burr hole) is a medical intervention in which a hole is drilled or scraped into the human skull, exposing the dura mater in order to treat health problems related to intracranial diseases. It may also refer to any "burr" hole created through other body surfaces, including nail beds. It is often used to relieve pressure beneath a surface. A trephine is an instrument used for cutting out a round piece of skull bone.

Evidence of trepanation has been found in prehistoric human remains from Neolithic times onwards. Cave paintings indicate that people believed the practice would cure epileptic seizures, migraines, and mental disorders.^[1] The bone that was trepanned was kept by the prehistoric people and probably worn as a charm to keep evil spirits away. Evidence also suggests that trepanation was primitive emergency surgery after head wounds^[2] to remove shattered bits of bone from a fractured skull and clean out the blood that often pools under the skull after a blow to the head. Such injuries were typical for primitive weaponry such as slings and war clubs.^[3]

There is some contemporary use of the term. In modern eye surgery a trephine instrument is used in corneal transplant surgery. The procedure of drilling a hole through a fingernail or toenail is also known as trephination. It is performed by a physician or surgeon to relieve the pain associated with a sub-ungual hematoma (blood under the nail); a small amount of blood is expressed through the hole and the pain associated with the pressure is partially alleviated.

Contents 1 History 1.1 Old World 1.2 Pre-Columbian Mesoamerica 2 Modern medicine 3 Voluntary trepanation 4 See also 5 Notes 6 External links

History

Main article: History of medicine

Old World

See also: Prehistoric medicine

1525 engraving of trepanation by Peter Treveris (taken from Hieronymus Braunschweig's Buch der Cirurgia. Hantwirckung der Wundartzny 1497

"The Extraction of the Stone of Madness" is a painting depicting trepanation in open air by Hieronymus Bosch (undated).

Trepanation is perhaps the oldest surgical procedure for which there is forensic evidence,^[4] and in some areas may have been quite widespread. Out of 120 prehistoric skulls found at one burial site in France dated to 6500 BC, 40 had trepanation holes.^[5] Many prehistoric and premodern patients had signs of their skull structure healing; suggesting that many of those subjected to the surgery survived.

Trepanation was also practiced in the classical and Renaissance periods. Hippocrates gave specific directions on the procedure from its evolution through the Greek age, and Galen also elaborates on the procedure.

During the Middle Ages and the Renaissance, trepanation was practiced as a cure for various ailments, including seizures and skull fractures. Out of eight skulls with trepanations from the 6th-8th centuries found in southwestern Germany, seven skulls show clear evidence of healing and survival after trepanation suggesting that the survival rate of the operations was high and the infection rate was low.^[2]

Pre-Columbian Mesoamerica

Main article: Trepanation in Mesoamerica

In pre-Columbian Mesoamerica, evidence for the practice of trepanation and an assortment of other cranial deformation techniques comes from a variety of sources, including physical cranial remains of pre-Columbian burials, allusions in iconographic artworks and reports from the post-colonial period.

Among New World societies, trepanning is most commonly found in the Andean civilizations such as the pre-Incan culture such as the Paracas Ica situated in what now is Ica located South of Lima. Its prevalence among Mesoamerican civilizations is much lower, at least judging from the comparatively few trepanated crania that have been uncovered.^[6]

The archaeological record in Mesoamerica is further complicated by the practice of skull mutilation and modification carried out after the death of the subject, to fashion "trophy skulls" and the like of captives and enemies. This was a widespread tradition, illustrated in pre-Columbian art that occasionally depicts rulers adorned with or carrying the modified skulls of their defeated enemies, or of the ritualistic display of sacrificial victims. Several Mesoamerican cultures used a skull-rack (known by its Nahuatl term, tzompantli ), on which skulls were impaled in rows or columns of wooden stakes.

Even so, some evidence of genuine trepanation in Mesoamerica (i.e., where the subject was living) has survived.

The earliest archaeological survey published of trepanated crania was a late 19th-century study of several specimens recovered from the Tarahumara mountains by the Norwegian ethnographer Carl Lumholtz.^[6][7] Later studies documented cases identified from a range of sites in Oaxaca and central Mexico, such as Tilantongo, Oaxaca and the major Zapotec site of Monte Albán. Two specimens from the Tlatilco civilization's homelands (which flourished around 1400 BC) indicate the practice has a lengthy tradition.^[8]

A study of ten low-status burials from the Late Classic period at Monte Albán concluded that the trepanation had been applied non-therapeutically, and, since multiple techniques had been used and since some people had received more than one trepanation, concluded it had been done experimentally. Inferring the events to represent experiments on people until they died, the study interpreted that use of trepanation as an indicator of the stressful sociopolitical climate that not long thereafter resulted in the abandonment of Monte Alban as the primary regional administrative center in the Oaxacan highlands.^{[citation needed]}

Specimens identified from the Maya civilization region of southern Mexico, Guatemala and the Yucatán Peninsula show no evidence of the drilling or cutting techniques found in central and highland Mexico. Instead, the pre-Columbian Maya apparently used an abrasive technique that ground away at the back of the skull, thinning the bone and sometimes perforating it, similar to the examples from Cholula. Many skulls from the Maya region date from the Postclassic period (ca. 950–1400), and include specimens found at Palenque in Chiapas, and recovered from the Sacred Cenote at the prominent Postclassic site of Chichen Itza in northern Yucatán.^[9]

Modern medicine

Trepanation is a treatment used for epidural and subdural hematomas, and for surgical access for certain other neurosurgical procedures, such as intracranial pressure monitoring. Modern surgeons generally use the term craniotomy for this procedure. The removed piece of skull is typically replaced as soon as possible. If the bone is not replaced, then the procedure is considered a craniectomy. Trepanation instruments are now available with diamond coated rims (Diamond Bone Cutting System), which are less traumatic than the classical trephines with sharp teeth. They are smooth to soft tissues and cut only bone.

Voluntary trepanation

Dr. John Clarke trepanning a skull, ca. 1664, in one of the earliest American portraits. Clarke was allegedly the first physician to perform the operation in America. The painting is in Boston Medical Library, Harvard University

Trepanated skull, Iron age. The perimeter of the hole in the skull is rounded off by ingrowth of new bony tissue, indicating that the patient survived the operation.^{[citation needed]}

Although widely considered today to be pseudoscience, the practice of trepanation for other purported medical benefits continues. Moreover recent research on the increase in cranial compliance following on trepanation, with resulting increase in blood flow[1], seems to vindicate some of the claims widely considered mere pseudoscience.

The most prominent folk theory for these benefits is offered by Dutchman Bart Huges (alternatively spelled Bart Hughes). He is sometimes called Dr. Bart Hughes although he did not complete his medical degree. Hughes claims that trepanation increases "brain blood volume" and thereby enhances cerebral metabolism in a manner similar to cerebral vasodilators such as ginkgo biloba. No published results have supported these claims.

Other modern practitioners of trepanation claim that it holds other medical benefits, such as a treatment for depression or other psychological ailments. In 2000, two men from Cedar City, Utah were prosecuted for practicing medicine without a license after they performed a trepanation on an English woman to treat her chronic fatigue syndrome and depression.^[10]

However, individuals may practice non-emergency trepanation for psychic purposes. A prominent proponent of the modern view is Peter Halvorson, who drilled a hole in the front of his own skull to increase "brain blood volume".^[5]

In a chapter of his book, Eccentric Lives & Peculiar Notions, John Michell describes a British group that advocates self-trepanation to allow the brain access to more space and oxygen. The chapter is called "The People With Holes in their Heads". Michell cites Bart Huges as pioneered the idea of trepanation specifically his 1962 monograph, Homo Sapiens Correctus, as most cited by advocates of self-trepanation. Among other arguments, he contends that children have a higher state of consciousness and since children's skulls are not fully closed one can return to an earlier, childlike state of consciousness by self-trepanation. Further, by allowing the brain to freely pulsate Huges argues that a number of benefits will accrue.

Michell quotes a book called Bore Hole written by Joey Mellen. At the time the passage below was written, Joey and his partner, Amanda Feilding, had made two previous attempts at trepanning Mellen. The second attempt ended up placing Mellen in the hospital, where he was reprimanded severely and sent for psychiatric evaluation. After he returned home, Mellen decided to try again. He describes his third attempt at self-trepanation:

After some time there was an ominous sounding schlurp and the sound of bubbling. I drew the trepan out and the gurgling continued. It sounded like air bubbles running under the skull as they were pressed out. I looked at the trepan and there was a bit of bone in it. At last!

Amanda Feilding also performed a self-trepanation with a drill, while her partner Joey Mellen filmed the operation, in the film titled Heartbeat in the Brain. The film has since been lost. Portions of the film can be seen, however, in the documentary A Hole in the Head.

In the movie Master and Commander: The Far Side of the World with Russell Crowe, a trepanation is performed on a crew member by the ship doctor; with the 'hole' filled in using a coin.

See also

• Mütter Museum
• Lobotomy

Notes

1. ^ Brothwell, Don R. (1963). Digging up Bones; the Excavation, Treatment and Study of Human Skeletal Remains. London: British Museum (Natural History). pp. 126. OCLC 14615536. 
2. ^ ^{a b} Weber, J.; and A. Czarnetzki (2001). "Trepanationen im frühen Mittelalter im Südwesten von Deutschland - Indikationen, Komplikationen und Outcome" (in German). Zentralblatt für Neurochirurgie 62 (1): 10. doi:10.1055/s-2001-16333. 
3. ^ The Skull Doctors - www.trepanation.com
4. ^ Capasso, Luigi (2002) (in Italian). Principi di storia della patologia umana: corso di storia della medicina per gli studenti della Facoltà di medicina e chirurgia e della Facoltà di scienze infermieristiche. Rome: SEU. ISBN 8887753652. OCLC 50485765. 
5. ^ ^{a b} Restak, Richard (2000). "Fixing the Brain". Mysteries of the Mind. Washington, D.C.: National Geographic Society. ISBN 0-792-27941-7. OCLC 43662032. 
6. ^ ^{a b} Tiesler Blos, Vera (2003) (PDF). Cranial Surgery in Ancient Mesoamerica. Mesoweb. http://www.mesoweb.com/features/tiesler/Cranial.pdf. Retrieved 2006-05-23. 
7. ^ Lumholtz, Carl (1897). "Trephining in Mexico". American Anthropologist 10 (12): 389. doi:10.1525/aa.1897.10.12.02a00010. 
8. ^ Romero Molina, Javier (1970). "Dental Mutilation, Trephination, and Cranial Deformation". in T. Dale Stewart (volume ed.). Handbook of Middle American Indians, Vol. 9: Physical Anthropology. Robert Wauchope (series ed.) (2nd. edition (revised) ed.). Austin: University of Texas Press. ISBN 0-292-70014-8. OCLC 277126. 
9. ^ Tiesler Blos, Vera (1999) (in Spanish). Rasgos Bioculturales Entre los Antiguos Mayas: Aspectos Culturales y Sociales. Doctoral thesis in Anthropology, UNAM. 
10. ^ Reporters Committee for Freedom of the Press (2000) ABC ordered to hand over unedited head-drilling tapes

External links

• WHO surgical instructions on burr holes
• Skeptic's Dictionary entry about Trepanation
• An illustrated history of trepanation
• Interview with self-trepanner Heather Perry

This entry is from Wikipedia, the leading user-contributed encyclopedia. It may not have been reviewed by professional editors (see full disclaimer)