Fronto-ethmoidal encephalocele in a historical skull with artificial deformation and no signs of chronic elevated intracranial pressure

The intentional deformation of human skulls in the living being was one of the most curious rituals performed in historical and ancient times. It is thought that these practices cause chronic elevated intracranial pressure and subsequent symptoms of cognitive impairment. In this report, we examine such an artificially deformed skull dating from the sixteenth century that in addition shows a fronto-ethmoidal encephalocele. However, although the mild encephalocele was already manifest at birth and deformation practices were performed over years, the encephalocele did not progress into a more severe status. We conclude that the intentional deformation of skulls does not lead to chronic elevated intracranial pressure and mental retardation.

[Artistic sketch of an abnormality from 1683]

Early-modern drawings of malformations are much less known than the woodcuts and etchings of deformed children reproduced and discussed on leaflets or in monographs. The present article publishes for the first time a drawing from 1682 showing the front and rear view of a deformed boy born in Rossla (modern Sachsen-Anhalt). These illustrations and two surviving written testimonia reveal very different attitudes to the malformed child on the part of the various individuals involved. Although the information in the sources is not sufficiently precise to allow an unequivocal retrospective medical diagnosis of the malformations, two possible interpretations are presented.

Cranial dysraphism mistaken for trephination

Attention is called to a disputed diagnosis of trephination reported for a perforated skull of a prehistoric New England Indian. The perforation, surrounded by a saucer-like depression, is located exactly in the midline just in front of bregma. The finding of a similar lesion in a prehistoric Indian skull from the North Coast of Peru--where, as in New England, good evidence of the practice of trephination is lacking--provides support for a more reasonable diagnosis for both cases: congenital cranial dysraphism, specifically encephalocele. Information about dysraphic states from modern clinical experience is summarized.