Survival after trepanation-Early cranial surgery from Late Iron Age Switzerland

Holes in the Head. Double cranial surgery on an individual from the Chalcolithic burial site of Camino del Molino (SE Spain)

OBJECTIVE

This article analyses new prehistoric evidence of trepanation from a collective burial site in the south-eastern Iberian Peninsula.

MATERIALS

The trepanned individual was documented in the Chalcolithic burial site of Camino del Molino, where 1348 individuals (30.7 % non-adults and 69.3 % adults) were deposited in two contiguous funerary phases, making it a reference site for the knowledge of Recent Prehistoric populations.

METHODS

The individual has been sexed using traditional anthropological methods and ancient DNA. C14 dating has also been obtained. The lesion has been analysed macroscopically and microscopically using SEM.

RESULTS

The skull under study belonged to an adult female deposited in the second burial phase (2566-2239 years cal BCE). It exhibits in the anterior region of the right temporal fossa two contiguous and partially overlapping holes that correspond to two trepanations performed using the scraping technique.

CONCLUSIONS

It is a double cranial trepanation with signs of bone remodelling suggesting survival from surgery. No pathological signs were identified potentially associated with the intervention.

SIGNIFICANCE

This is the second case of surgical interventions in the geographical area of study and one of the few evidences of this practice in women during prehistoric times.

LIMITATIONS

So far only the articulated skeletons from this burial have been thoroughly analysed.

SUGGESTIONS FOR FURTHER RESEARCH

Further intensive review of skull collection is advised to learn more about these surgical interventions in Copper Age and to go deeper into the causes that motivated their execution.

As above, so below: Deposition, modification, and reutilization of human remains at Marmoles cave (Cueva de los Marmoles: Southern Spain, 4000-1000 cal. BCE)

The deposition and manipulation of human remains in natural caves are well known for the Neolithic of Southern Iberia. The cultural meaning of these practices is however still largely unclear. Cueva de los Marmoles (CM, Priego-Córdoba) is one of the most important cave contexts from Southern Spain, which returned a large number of commingled skeletal remains suggesting its funerary use from the Neolithic to the Late Bronze Age. Here we discuss CM from a chronological and cultural perspective based on new radiocarbon, anthropological, and taphonomic analyses. These include the estimation of the minimum number of individuals, the exploration of fragmentation patterns characterizing different skeletal regions, and the macroscopic and microscopic analysis of modifications to the remains of possible anthropic origin. Radiocarbon data point to a funerary use of CM between the 5th -2nd millennium cal. BCE. MNI estimates reveal the presence of at least 12 individuals (seven adults and five nonadults). The low representation of elements from hands and feet suggests that individuals were placed in the cave while partially decomposed. Anthropic traces on the remains (e.g. fresh fractures, marrow canal modifications, and scraping marks) hint at their intentional fragmentation, cleaning from residual soft tissues, and in some cases reutilization. These practices are well-exemplified by the recovery of one "skull cup" and of two long bones used as tools. These data align with those from other cave contexts from the same geographic region, suggesting the presence, especially during the Neolithic period, of shared ideologies centered on the human body.

The Late Iron Age in Switzerland: a review of anthropological, funerary, and isotopic studies

The Iron Age in continental Europe is a period of profound cultural and biological importance with heterogeneous trends through space and time. Regional overviews are therefore useful for better understanding the main cultural and biological patterns characterizing this period across the European regions. For the area of modern Switzerland, a rich archeological and anthropological record represents the Late Iron Age. However, no review of the main anthropological and funerary patterns for this period is available to date. Here we assess the available demographic, paleopathological, funerary, and isotopic data for the Late Iron Age in the Swiss territory, and summarize the cultural and biological patterns emerging from the available literature. Finally, we highlight a series of research avenues for future studies.

The role of case studies in recent paleopathological literature: An argument for continuing relevance

OBJECTIVE

To critically examine the role that case studies play in recent paleopathological literature, by evaluating their frequency of publication, academic impact, and the public engagement they generate.

MATERIALS

Articles published in International Journal of Paleopathology between 2011 and 2018 (N = 377).

METHODS

Articles were coded as case studies, population studies, methodological studies, or reviews. Case studies were coded as cultural practices, differential diagnosis, historical, or methodological/theoretical. We utilized bibliometric analysis to assess academic impact and altmetric analysis to evaluate public engagement.

RESULTS

Case studies continue to be the most frequently published, but least frequently cited, article type. There are no significant differences in public engagement data between article types. Methodological/theoretical case studies have the most academic impact. Differential diagnosis case studies have the least academic impact and generate the least public engagement.

CONCLUSIONS

The case study genre includes a variety of approaches, some of which hold significant potential for contributing to the discipline of paleopathology and beyond.

SIGNIFICANCE

This study updates Mays' (2012b) citation analysis, pioneers the use of altmetric data to analyze public engagement with paleopathological publications, and identifies less productive approaches and areas of heightened relevance in the case study genre.

LIMITATIONS

Publications in only one journal were analyzed. Only one source was utilized for citation data (Google Scholar) and one source for altmetric data (PlumX).

SUGGESTIONS FOR FUTURE RESEARCH

Expanding the granular analysis of case studies piloted here to additional journals and/or citation indexes to enlarge the sample size and provide keener insights.

Case study: trepanation or injury? An example of an early medieval skull from Płock (Poland)

The aim of the study was to analyze a skull found in ossuary material in Płock, dated between the 16th and 19th centuries. The skull was subjected to a comprehensive anthropological analysis due to the number of pathological changes occurring to it. These changes testify to both the diseases experienced by the individual and the acquired bone injuries. The study aimed to find out whether the pathological changes on the skull appeared as a result of the injury or intentional trepanation. The examined skull shows three injuries, of which only one may resemble trepanation processes. Comparative analysis of the skull showed that the observed marks were generated ante-mortem. The presence of compact regenerated bone tissue with a significant thickness attests to this statement. Based on the trauma marks, it was determined that two of them (“A” and “B”) had been struck by a sharp-edged instrument. They do not, however, match any known trepanation techniques. They should be categorized as purposeful injuries that are not trepanations, based on the proportions and shape of the incisions, as well as the comparative study. The “C” trace, when examined and compared to the literature, appears to be an oval depression caused by an impact with a blunt-edged object rather than a healed trepanation mark.

Trepanations in the ancient Greek colony of Akanthos: Skull surgery in the light of Hippocratic medicine

OBJECTIVE

The study presents seven new cases of trepanations on four individuals from the ancient Greek colony of Akanthos (5th - 1st c. BC) and juxtaposes the paleopathological observations with the Hippocratic treatises.

MATERIALS

A meta-analysis of 42 published trepanations on 27 individuals from Greece.

METHODS

Trepanations from Akanthos were observed macroscopically, stereoscopically and by computer tomography. The meta-analysis considers the demographic, geographical and temporal distribution, the techniques, associated pathology, and survival rate.

RESULTS

Trepanations were observed on four females in Akanthos. Three trepanations were performed with scraping and four with drilling. Two individuals exhibited significant signs of healing, and two survived shortly after the operation. In two cases, trepanation was practiced for treating cranial injuries. In Greek antiquity trepanation was performed predominantly in males, principally as a surgical treatment of cranial injuries. The survival rate was 62.9 %. Scraping was the oldest, most frequent and successful technique.

CONCLUSIONS

Trepanation performed systematically in Greece since the Bronze Age (ca. 2,000 BC). Hippocrates who rationally conceived medicine, codified the pre-existing empirical knowledge. The trepanations from Akanthos show technical similarities but also discrepancies from the Hippocratic recommendations, confirming the mental and technical readiness of the ancient surgeon.

SIGNIFICANCE

The synchronous to Hippocrates trepanations from Akanthos, provide the opportunity to compare physical evidence with the written sources.

LIMITATIONS

The frequency of trepanations is affected by the representativeness and the state of the skeletal preservation.

SUGGESTIONS FOR FUTURE RESEARCH

Trepanations published in previous decades, need to be reassessed with new imaging modalities. A standard recording methodology is fundamental for data comparison.

Cranial Surgery in Italy During the Bronze Age

Skull vault trepanation is a surgical practice that has been found in prehistoric human remains. We carried out a review of the literature on cranial trepanations performed during the Bronze Age in Italy. In total, 19 individuals, most of whom were adult males, with 33 trepanations have been reported, including a new specimen from the Italian Middle Bronze Age (1700-1400 BCE), found at Grotta della Monaca (Calabria). The evidence of cranial trepanations is geographically uneven across Italy, with the highest occurrence in Sardinia. Several trepanation techniques were applied in Italy during this period, where the drilling method was the most common solitary technique utilized. The survival rate of 79.3% in Bronze Age Italy suggests that trepanation was carried out with remarkable success. This analysis gives further insight into ancient human behavior and enhances our knowledge of surgical practices in antiquity, shedding light on the origins of neurosurgery.

Cranial trepanation and healing process in modern patients-Bioarchaeological and anthropological implications

The diagnosis of cranial trepanation in the archaeological record has always been a big challenge for archaeologists. The identification is first and foremost based on the shape and edges of the opening, and in cases where the individual survived, the shape and edges resulted from both the surgical procedure and the healing process. Because of the lack of reliable data on the osseous remodelling process of the skull, it is difficult to distinguish true trepanations from some pathological or physiological defects called pseudotrepanations. Furthermore, it is challenging to investigate the post-operative survival time. The purpose of this paper was to summarize observations made on a total of 90 archaeological samples of cranial lesions interpreted as 'partially' or 'completely' healed trepanations, and compare them with 14 modern case studies. Observations made on monitoring post-operative scans of modern patients, at varying times after craniotomy, provided a preliminary timetable for the successive post-surgery bony changes in the skull, and confirmed that the process of osseous remodelling does lead to smooth and rounded edges of the profile of the opening. However, contrary to what has been observed in several archaeological case studies, none of the cases shows a complete closure of the cranial vault. The sharp vertical edges of the opening become bevelled at late stages of healing, which has to be taken into consideration when interpreting the procedures and methods in past population. By bridging bioarchaeology and medical sciences, this study adds to previous discussions on the diagnosis of healed trepanation in the archaeological record, by providing detailed descriptions of morphological changes at various healing stages, that may help archaeologists to identify ancient trepanations more accurately.

A Student's Guide to Neural Circuit Tracing

The mammalian nervous system is comprised of a seemingly infinitely complex network of specialized synaptic connections that coordinate the flow of information through it. The field of connectomics seeks to map the structure that underlies brain function at resolutions that range from the ultrastructural, which examines the organization of individual synapses that impinge upon a neuron, to the macroscopic, which examines gross connectivity between large brain regions. At the mesoscopic level, distant and local connections between neuronal populations are identified, providing insights into circuit-level architecture. Although neural tract tracing techniques have been available to experimental neuroscientists for many decades, considerable methodological advances have been made in the last 20 years due to synergies between the fields of molecular biology, virology, microscopy, computer science and genetics. As a consequence, investigators now enjoy an unprecedented toolbox of reagents that can be directed against selected subpopulations of neurons to identify their efferent and afferent connectomes. Unfortunately, the intersectional nature of this progress presents newcomers to the field with a daunting array of technologies that have emerged from disciplines they may not be familiar with. This review outlines the current state of mesoscale connectomic approaches, from data collection to analysis, written for the novice to this field. A brief history of neuroanatomy is followed by an assessment of the techniques used by contemporary neuroscientists to resolve mesoscale organization, such as conventional and viral tracers, and methods of selecting for sub-populations of neurons. We consider some weaknesses and bottlenecks of the most widely used approaches for the analysis and dissemination of tracing data and explore the trajectories that rapidly developing neuroanatomy technologies are likely to take.

New Evidence of Prehistoric Neurosurgery in Italy: The Case of Castello Del Tartaro

Archaeological evidence of trepanation during the European Bronze Age is numerous and testifies a wide application of neurosurgical practices during prehistory. In some particular cases, trepanation may be associated with other peculiar evidence concerning funerary practices. The aim of this paper is to present the case of a woman from the Recent Bronze Age site of Castello del Tartaro (Verona, Italy), who was buried in a prone position and whose skeletal remains presented evidence of probable frontal trepanation. The association between a deviant burial and trepanation could be of interest in better understanding the history and perception of neurosurgical practices during prehistory.

Tackling the Concept of Symbiotic Implantable Medical Devices with Nanobiotechnologies

This review takes an approach to implanted medical devices that considers whether the intention of the implanted device is to have any communication of energy or materials with the body. The first part describes some specific examples of three different classes of implants, analyzed with regards to the type of signal sent to cells. Through several examples, the authors describe that a one way signaling to the body leads to encapsulation or degradation. In most cases, those phenomena do not lead to major problems. However, encapsulation or degradation are critical for new kinds of medical devices capable of duplex communication, which are defined in this review as symbiotic devices. The concept the authors propose is that implanted medical devices that need to be symbiotic with the body also need to be designed with an intended duplex communication of energy and materials with the body. This extends the definition of a biocompatible system to one that requires stable exchange of materials between the implanted device and the body. Having this novel concept in mind will guide research in a new field between medical implant and regenerative medicine to create actual symbiotic devices.

Trepanation in the Late Bronze Age and Early Iron Age in Armenia

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 65 years. Among nine cases of surgical trepanations four had possible healing signs. In these cases the individuals showed evidence of previous trauma to the skull or infection (mastoiditis, tuberculosis), suggesting that the operation had been carried out for therapeutic purposes. This provides further support for the suggestion that trepanation (or trephination) was performed primarily for therapeutic purposes, and because of cranial infection or injury. In one case, a symbolic trepanation could imitate real penetration into the skull cavity. This study shows that archaeological sites of Armenia and anthropological materials have a potential to supply essential information on ancient history of the Armenian people and the region.