[The mystery of prehistoric trepanations: Is neurosurgery the world eldest profession?]

Trepanations in non-adults of the 16th to 18th C. The osteological series of the Church of the Assumption of Valdepeñas (Ciudad Real, Spain)

OBJECTIVE

To investigate the presence of trepanations in an early Modern Age, skeletal collection documented in medical treatises but infrequently reported in osteological collections.

MATERIALS

Analyses were conducted on 387 non-adult crania from the ossuary in the church of the Assumption of Valdepeñas (16th - 18th C.), Ciudad Real, Spain.

METHODS

All complete or semi-complete crania of non-adults (aged 3-20 years) were macroscopically examined.

RESULTS

Trepanation was detected in two adolescents aged 14 and 20 years; no evidence of their survival was observed.

CONCLUSIONS

These findings suggest that trepanation was carried out in rural areas as Valdepeñas in the 16th-18th centuries, where the selection of instruments indicates knowledge of contemporaneous medical treatises.

SIGNIFICANCE

The present study provides new data on trepanation and how it was performed in adolescents during this period.

LIMITATIONS

Understanding the motive for these interventions is highly challenging in the absence of bone lesions, and their occurrence is likely underestimated due to the scant research in skeletal remains from the early Modern Age.

SUGGESTIONS FOR FUTURE RESEARCH

Further palaeopathological analyses of osteological collections from this period will provide more information about how this surgical technique was perfected.

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.

[The origins of the French neurosurgery]

Modern French neurosurgery starts at the beginning of the XXth century under the motivation of Joseph Babinski. He submitted his patients to Thierry de Martel who had learned this new specialized area of medicine with H. Cushing in the États-Unis and V. Horsey in Great Britain. His first successfully treated case of an intracranial tumor was published in 1909. But the true founding father was Clovis Vincent, initially a neurologist and collaborator of de Martel, who became the first chairman in 1933 of the neurosurgical department at the Pitié hospital of Paris and the first professor of neurosurgery in 1938. After the Second World War, many departments were created outside of Paris. Neurosurgery was definitively recognized as a specialized area in medicine in 1948. Currently, more than 400 neurosurgeons work in France. Because I had the very great privilege to be present at the birth of this society in 1970 and to still be in contact with some of the second and third generation of French neurosurgeons who led it to its high international recognition, the Chairman of the French Neurosurgical Society asked me to write this short historical vignette.

Brain abscess: Current management

Brain abscess (BA) is defined as a focal infection within the brain parenchyma, which starts as a localized area of cerebritis, which is subsequently converted into a collection of pus within a well-vascularized capsule. BA must be differentiated from parameningeal infections, including epidural abscess and subdural empyema. The BA is a challenge for the neurosurgeon because it is needed good clinical, pharmacological, and surgical skills for providing good clinical outcomes and prognosis to BA patients. Considered an infrequent brain infection, BA could be a devastator entity that easily left the patient into dead. The aim of this work is to review the current concepts regarding epidemiology, pathophysiology, etiology, clinical presentation, diagnosis, and management of BA.