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The trepanation, a surgical procedure performed on the skull, finds its roots in prehistoric times. This investigation delves into the analysis of the trepanned skulls housed at the Musée de l'Homme in Paris, focusing on those found in France, a region abundant in archaeological evidence of early neurosurgical techniques. With the opportunity to scrutinize these human remains, our study aimed to analyze the dimensions of Neolithic trepanations across 41 skulls. We particularly explored the relationships between minimum and maximum hole diameters, revealing a strong interrelation. Additionally, we successfully applied a straightforward protocol to determine the perforation area in ten Neolithic trepanations. These findings shed light on the medical practices of ancient civilizations, particularly in France during the Neolithic era. Moreover, this study underscores the significance of museum collections as valuable resources for scientific inquiry and the historical understanding of medicine. [ABSTRACT FROM AUTHOR]

Simple Summary: To date, there are very few studies of the bony nasal cavity of the domestic cat and even fewer of big felids. A detailed and exhaustive anatomical study of this cavity in the domestic cat is presented in this paper through dissections, trepanations and anatomical sections. This work has allowed to delve deeper into the anatomy of the bony nasal cavity. This study deepens the knowledge of this region through diagnostic imaging techniques, such as computed tomography, three-dimensional reconstruction in maximum-intensity projection and volume rendering, that allow for the spatial visualization of this cavity. These reconstructed images represent an improvement in the anatomical study of the cavity and will help veterinary clinicians in the diagnosis of nasal pathologies. Obtaining molds by three-dimensional printing allows for acquiring models very close to reality that capture these structures in detail. These techniques, which in human medicine have already led to many clinical and therapeutic improvements, are a very useful tool in veterinary medicine that will lead to advances and improvements in the diagnosis and treatment of nasal pathologies, improving the survival of many threatened species. This study aims to develop three-dimensional printing models of the bony nasal cavity and paranasal sinuses of big and domestic cats using reconstructed computed tomographic images. This work included an exhaustive study of the osseous nasal anatomy of the domestic cat carried out through dissections, bone trepanations and sectional anatomy. With the use of OsiriX viewer, the DICOM images were postprocessed to obtaining maximum-intensity projection and volume-rendering reconstructions, which allowed for the visualization of the nasal cavity structures and the paranasal sinuses, providing an improvement in the future anatomical studies and diagnosis of pathologies. DICOM images were also processed with AMIRA software to obtain three-dimensional images using semiautomatic segmentation application. These images were then exported using 3D Slicer software for three-dimensional printing. Molds were printed with the Stratasys 3D printer. In human medicine, three-dimensional printing is already of great importance in the clinical field; however, it has not yet been implemented in veterinary medicine and is a technique that will, in the future, in addition to facilitating the anatomical study and diagnosis of diseases, allow for the development of implants that will improve the treatment of pathologies and the survival of big felids. [ABSTRACT FROM AUTHOR]

В статье представлены результаты исследования мужского черепа со следами трепанации. Погребение, где обнаружен краниум, относится к Ходжалы-Кедабекской археологической культуре эпохи поздней бронзы-раннего железа и было выявлено в ходе археологических раскопок Я.И. Гуммеля в Гёйгёльском районе. Трепанационное отверстие, общими размерами 2,4 × 2 см, округлой формы, расположено на венечном шве, на соединении лобной и левой теменной кости. Краниотомия была совершена методом скобления и прорезывания. На черепе присутствуют следы воспалительной реакции и заживления кости. Пациент прожил определённое время после операции. Манипуляция была осуществлена, вероятно, в медицинских целях. На черепе отмечены также дискретные признаки и маркеры физиологического стресса. В настоящее время известно 8 случаев трепанации, датируемых концом II — началом I тыс. до н.э. с территории Азербайджана: из них два (мужчины) совершены прижизненно в медицинских целях методом скобления и прорезывания (один успешно, второй — окончился смертью пациента); шесть в ритуально-символических целях, из них четыре — прижизненно выполнены методом прижигания (мужчина, женщина, два взрослых индивидуума) и два — посмертно (женщина и мужчина), методом прорезывания.

Complexities in obturation and difficulties in disinfection are the major problems that make endodontic treatment very time-consuming. A new perspective is needed to reduce the working time as well as to answer these two problems. Until now, none of the established obturation techniques for root canal filling can guarantee a perfect seal. Solid substances cannot be manipulated easily to fill the tiny branches of the root canal system hermetically. At the same time, anaerobes and facultative anaerobes, especially Enterococcus faecalis, are very dominant in endodontic infections discussion. As shown in many studies, it is extremely difficult to perfectly disinfect Enterococcus faecalis even by using some irrigating solutions with strong antibacterial properties. Under anaerobic conditions, the invasion efficiency of facultative anaerobes is increased. In case irrigation and disinfection cannot totally eliminate anaerobes and facultative anaerobes, a new strategy is also needed to deal with the bacteria that still survive in the root canal. Oxygen can fill the root canal system with ease, eliminate anaerobes, and prevent facultative anaerobes from being pathogenic. Therefore, using oxygen as obturation biomaterial after proper cleaning and shaping procedures is expected to solve the two major endodontic problems. The aim of this article was to discuss a new possible concept of dental restoration system that uses an oxygen-permeable membrane to decrease the time required in endodontic treatment. The membrane is placed at the orifice of a duct created to connect the entire root canal system with free air outside the restoration. The function of the membrane is more or less similar to the mask used during the COVID-19 pandemic, as it enables the oxygen to circulate while preventing any fluid, debris, and microorganisms from passing. We hypothesize that the oxygen circulating in the root canal system will also act as an antimicrobial agent that is constantly renewed.

Osteological data from Late Bronze a nad Early Iron Ages skeletal series provide insight into health, disease, and stress levels in Bardzryal site (Armenia, Lori Region). The sample was recovered during excavations in 2009 and 2018. Fifty-five skeletons from burial ground Bardzryal were analyzed macroscopically and X-ray for pathological conditions such as traumatic injuries, trepanation, infectious disease, and dental pathology. This study has shown that average age at death was relatively high. Life expectancy at birth for the Bardzryal population is 36.3 years. Traumatic injuries appear to have been common (23.7%). Six individuals show evidence of strenuous physical activity. Recent discoveries in Lori province have revealed that this area represents one of the most active centers of cultural transformation in the medical field. The Bardzryal individuals (2 cases) represent an important example of successful surgery in the Late Bronze and Early Iron Ages. Cases of benign neoplasm's observed in group (3 individuals) should be viewed as non-life-threatening disorders. Bardzryal site showed a high frequency of auditory exostosis (54.6%). Four men from this cemetery are of special interest owing to the presence of lesions associated with a chronic ear infection. Tuberculosis (33.3%), brain abscess (36.4%), chronic osteomyelitis (1 individual) also were present in the Bardzryal population. The dental pathology conditions of this population were numerous. Agriculture introduced people to carbohydrates, or sugars, which affect the teeth and cause dental caries (29.04%). The staple diet of ancient population from Lori Region (Shnogh River) consisted of wine, bread, vegetables, and fruits. [ABSTRACT FROM AUTHOR]

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Copyright of Stratum Plus Journal is the property of P.P. Stratum plus and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

The article presents paleoanthropological materials from the early period of the functioning of the Berel burial mound Pazyryk culture. The monument is located in Altai (Republic of Kazakhstan). The author presents craniological, odontological data and evidence of post-mortem manipulations with the bones of individuals from large mounds that belonged to people of high social status. The physical characteristics of the population represented in the burial mound find analogies both in the Pazyryk culture and among the population of the Saka cultures of Central Asia. The presence of a female skull with a Mongoloid appearance in mound 16 confirms already existing ideas about the participation of individuals with an eastern, Mongoloid appearance in the full life of the Pazyryk community. Post-mortem manipulations with bodies, traces of which are recorded on the skeletal remains of persons of high social status at the Berel burial mound, significantly complement the database for understanding the nuances of burial traditions associated with the artificial mummification of bodies. Farewell ceremonies in a nomadic lifestyle are not always possible in a short time. It can be assumed that the mummification of bodies was a preparatory stage for a complex and lengthy process of farewell traditions before the burial of the body in an arid climate.

This study aims to develop three-dimensional printing models of the bony nasal cavity and paranasal sinuses of big and domestic cats using reconstructed computed tomographic images. This work included an exhaustive study of the osseous nasal anatomy of the domestic cat carried out through dissections, bone trepanations and sectional anatomy. With the use of OsiriX viewer, the DICOM images were postprocessed to obtaining maximum-intensity projection and volume-rendering reconstructions, which allowed for the visualization of the nasal cavity structures and the paranasal sinuses, providing an improvement in the future anatomical studies and diagnosis of pathologies. DICOM images were also processed with AMIRA software to obtain three-dimensional images using semiautomatic segmentation application. These images were then exported using 3D Slicer software for three-dimensional printing. Molds were printed with the Stratasys 3D printer. In human medicine, three-dimensional printing is already of great importance in the clinical field; however, it has not yet been implemented in veterinary medicine and is a technique that will, in the future, in addition to facilitating the anatomical study and diagnosis of diseases, allow for the development of implants that will improve the treatment of pathologies and the survival of big felids.

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To provide a historic snapshot as regards the evolution of headache treatment throughout the human history, i.e. starting from trepanation to perisutural botulinum toxin (BoNT) injections. Ancient surgeons had aimed to reach the cranium with trepanation (a surgical operation) for headache. As BoNT inhibits the release of nociceptive and pro-inflammatory neuropeptides, it has been recently suggested as an effective alternative in the prophylactic treatment of chronic migraine headache. Chronic migraine is a complex neurological disorder for which the underlying pathophysiology is yet not totally explained. According to the generally accepted hypotheses, peripheral neurogenic activation and central trigeminal sensitization are the two main mechanisms through which its pain develops. Since the headache most commonly occurs around the perisutural areas, and as the primary pathogenesis stem from the meningeal nerve fibers; collateral sensorial branches of the meningeal nerves can be optimal paths to transport BoNT inside the cranium. Concerning the therapeutic efficacy, we anticipate that perisutural injections would be technically challenging with blind techniques and actually possible only if performed under an imaging guidance, e.g. very conveniently with high frequency ultrasound. [ABSTRACT FROM AUTHOR]

In dermatology, a keloid is one of the most common skin morphological abnormalities caused by excessive proliferation of fibroblasts. Keloids that are large or occur near important joint sites often cause varying degrees of physiological dysfunction in patients, therefore requiring medical treatment. A boy with congenital syndactyly developed huge keloids at the surgical site after undergoing surgical correction treatment. After treatment using trepanation combined with superficial radiotherapy (SRT-100) in our hospital, most of the boy’s keloids shrank and flattened. The affected foot returned to its normal appearance, and the boy could wear shoes normally. The boy did not complain of pain, numbness, or any other distinctive discomfort after completing the treatment. This suggested that the combination of trepanation and SRT-100 may be one of the options for treating hypertrophic keloids that cannot be treated by surgical excision.

This work is focused on a case of trepanation reported in a skeletal sample found in a necropolis from Iaşi (Romania). According to the discovered coins, the time limits of necropolis use are set between the 17th and 19th centuries. In the study, the classical paleoanthropological and paleopathological methods, stereomicroscopy, dental wear, nonmetric dental traits were applied. The skeleton under analysis belonged to an adult male of 35–40 years (middle adult). The preservation status of the skeleton is satisfactory. At the level of the skull (on the parietal bones), two perforations were identified, diagnosed as trepanations. The craniotomy was realized intra-vitam, most probably for medical/ therapeutic purposes. Tripartite Inca bone was reported on the lambdoid suture. Dentition is characterized by moderately advanced predominant wear and antemortem microfractures in both anterior and posterior teeth. The particularities of this individual are defined by the supernumerary roots and the asymmetry of traits in the second upper incisor. Supragingival and subgingival dental calculus (moderate amount) is present at the level of the lower first and second incisors (I1, I2) (labial and lingual surface). At the level of the postcranial skeleton, perforation of the sternum (sternal foramina) and Schmorll’s nodule in three thoracic and two lumbar vertebrae were reported.

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This paper aims to bring back to life an underrated, even forgotten surgeon of the late first century B.C.E., Meges of Sidon. He was an experienced surgeon of his time and was considered the most erudite Roman surgeon before Galen. He belonged to the Alexandria School of Medicine and later migrated to Rome to practice. Although most of his work did not survive, he was mentioned by notable ancient figures, such as Celsus and Galen. He excelled in various surgical specialties, not limited to neurosurgery, orthopedics, ophthalmology, and urology. Galen cited Meges in his surgical book on head injuries and cranial procedures. Meges was known to have invented a "double-edged" blade that he used to remove stones from the neck of the bladder. His treatment of anal fistulas was a reference through the Middle Ages. Celsus, a Roman encyclopedist of the first century, would later erroneously receive credit for ancient surgical innovations, such as the nonslipping cranial drill and the treatment of depressed skull fractures, even though he was not a surgeon. However, as Celsus was going over the history of surgery, he described Meges as the "most learned" of its prominent figures. Meges' neurosurgic techniques and teachings are deduced from Celsus, who shortly succeeded him, did not practice surgery, and acknowledged him as his primary source on surgical topics. [ABSTRACT FROM AUTHOR]

To trace the evolution of ideas and practice in the management of meningeal injury from the ancient world to the end of the 18th century. The texts of significant surgical practitioners from Hippocrates to the 18th century were examined and analyzed. The dura was first described in ancient Egypt. Hippocrates insisted that it should be protected and not penetrated. Celsus proposed an association between clinical findings and intracranial damage. Galen proposed that the dura was attached only at the sutures, and he was the first to describe the pia. In the Middle Ages, new interest in the management of meningeal injuries arose, with renewed interest in relating clinical changes to intracranial injuries. These associations were neither consistent nor accurate. The Renaissance brought little change. It was in the 18th century that it became clear that the indication for opening the cranium following trauma was to relieve pressure from hematomas. Moreover, the important clinical findings on which to base an indication for intervention were changes in the level of consciousness. The evolution of the management of meningeal injury was colored by erroneous concepts. It was not until the Renaissance and finally the Enlightenment that a milieu developed that permitted examination, analysis, and clarification of the underlying processes that could lead to rational management. [ABSTRACT FROM AUTHOR]

Objective: Cranial fissures are not an indication for surgical intervention. It should be emphasised that the term fissure refers to linear skull fractures as defined in MESH. However, it was the universal term for this injury in the literature which forms the basis of this paper. Nonetheless, for over two millennia, their management was a major reason for opening the skull. The reasons for this deserve analysis, in particular taking into account the available technology and conceptual background. Materials and methods: The texts of significant surgical practitioners from Hippocrates to the eighteenth century were examined and analyzed. Results: The need for fissure surgery was based on Hippocrates' teaching. It was considered that extravasated blood would suppurate, and extracranial suppuration could leak inwards through a fracture. Trepanation to facilitate pus drainage and cleansing was considered vital. Avoiding surgical damage to the dura was also emphasized with a preference for operating only when the dura had separated from the cranium. The enlightenment with an increasing reliance on personal observation rather than the teachings of received authority enabled the accumulation of a more rational basis for treatment concerned with the effects of injury on brain function. This culminated in the teachings of Percivall Pott, who despite some minor errors, provided the framework on which modern treatments would develop. Conclusions: Examination of the surgical management of cranial trauma from Hippocrates to the eighteenth century shows that cranial fissures were judged to be of great importance and required active treatment. This treatment was not aimed at improving the healing of the fracture but at avoiding deadly intracranial infection. It is worth noting that this sort of treatment persisted for over two millennia while modern management has only been practiced for just over a century. Who can say how it will change in the next hundred years. [ABSTRACT FROM AUTHOR]

Abstract Introduction Materials and Methods Results Conclusions While the calvarial sutures have a limited importance for the modern neurosurgeon, they were of considerable interest to cranial surgeons from the time of Hippocrates onwards. The reasons for this interest together with the evolution of ideas are the subjects of this paper.The texts of surgeons from the time of Hippocrates to the eighteenth century have been studied and analysed.Hippocrates advised against trepanation through a suture without specifying why. Galen taught that the dura was only attached to the interior of the calvarium at the sutures. The first author to state that the attachment was diffuse was Berengario da Carpi, at the beginning of the sixteenth century. This teaching was subsequently ignored until the eighteenth century, from which time it has been universally accepted. It was also first emphasized in the eighteenth century that it was not dangerous to trepan at the sutures.This study documents the persistence of incorrect ideas from classical times to the middle of the eighteenth century. These notions would have limited the regions available for surgical access to the skull and thereby limited the benefits to be derived from surgery. [ABSTRACT FROM AUTHOR]

Complexities in obturation and difficulties in disinfection are the major problems that make endodontic treatment very time-consuming. A new perspective is needed to reduce the working time as well as to answer these two problems. Until now, none of the established obturation techniques for root canal filling can guarantee a perfect seal. Solid substances cannot be manipulated easily to fill the tiny branches of the root canal system hermetically. At the same time, anaerobes and facultative anaerobes, especially Enterococcus faecalis, are very dominant in endodontic infections discussion. As shown in many studies , it is extremely difficult to perfectly disinfect Enterococcus faecalis even by using some irrigating solutions with strong antibacterial properties. Under anaerobic conditions, the invasion efficiency of facultative anaerobes is increased. In case irrigation and disinfection cannot totally eliminate anaerobes and facultative anaerobes, a new strategy is also needed to deal with the bacteria that still survive in the root canal. Oxygen can fill the root canal system with ease, eliminate anaerobes, and prevent facultative anaerobes from being pathogenic. Therefore, using oxygen as obturation biomaterial after proper cleaning and shaping procedures is expected to solve the two major endodontic problems. The aim of this article was to discuss a new possible concept of dental restoration system that uses an oxygen-permeable membrane to decrease the time required in endodontic treatment. The membrane is placed at the orifice of a duct created to connect the entire root canal system with free air outside the restoration. The function of the membrane is more or less similar to the mask used during the COVID-19 pandemic, as it enables the oxygen to circulate while preventing any fluid, debris, and microorganisms from passing. We hypothesize that the oxygen circulating in the root canal system will also act as an antimicrobial agent that is constantly renewed.

Chronic subdural hematoma (CSDH) is increasingly common, particularly in the older and multimorbid population. Surgical proficiency in management is required in the early years of U.K. neurosurgical training with most cases performed by nonconsultant-grade surgeons. The aim of this systematic review was to examine the effect of surgeon seniority on recurrence for patients with CSDH. Full-text articles comparing surgical treatment for CSDH with a "senior" (consultant/attending level) or "junior" (resident/registrar or similar) lead surgeon were identified. MEDLine and EMBASE databases were searched. The primary outcome of this study was recurrence. Secondary outcomes included postoperative complications and mortality rate. A random effects meta-analysis was performed. The risk of bias was assessed using the National Institute of Health risk of bias toolkit. Five studies were included in the final analysis (n = 941 total patients). Individually, no study identified a significant difference in recurrence rate and postoperative complications between senior and junior neurosurgeons. On meta-analysis, junior-led evacuations had lower recurrence rates on pooled univariable analysis (12.0% vs. 17.9% [odds ratio 0.48, 95% confidence interval 0.29–0.78, I2 = 0%]) (3 studies). Seniority of surgeon was not associated with increased rates of recurrence patients undergoing CSDH surgery. Complexity of operation may be a confounding factor in observed lower recurrence rates with more junior operators. [ABSTRACT FROM AUTHOR]

The paper presents craniological materials from the so-called «Cult barrow» or kurgan №36 from excavations (field season of 1937 year) of Azerbaijani archaeologist Y.I. Hummel. Kurgan was situated in the valley of Ganjachai to the west from Goygol city (Azerbaijan Republic). Here were identified the burials of different historical periods: the Early Bronze Age (Kura-Araxes archaeological culture), the Late Bronze – Early Iron Ages (Khojaly-Gedabek archaeological culture) and Medieval. The studied materials belong to the Late Bronze – Early Iron Ages (Khojaly-Gedabek archaeological culture) and date back to the end of II – beginning of I Millennium BC. Four skulls were researched in total: three male (No 1–3) and one female (No 4). There is likelihood that male and female skulls from «Cult barrow» belonged to the south branch of the Caucasoid race and referred to its brachycranial variant, which had been widespread in Ganja-Gazakh region of Azerbaijan since The Early Bronze Age. The results of the study allow us to conclude that the people buried in the zhalnik of the mound were the autochthons of this zone of Azerbaijan, this statement does not contradict the archaeological materials found near the buried. There is a certain continuity of the population on the territory of the Ganja-Gazakh region of Azerbaijan from the era of the Early – Late Bronze – Early Iron – Middle Ages and up to the modern period.

This study presents five graves discovered east of the Palace Centre in Pliska (fig. 1). They represent individual burials located in the inter-dwelling area (fig. 2). The graves’ contexts were studied interdisciplinarily. The archaeological study provided data on the stratigraphy of the graves and detailed documentation of the burial pits and skeletal remains. The anthropological study provided information about the sex, age and height of the buried individuals, also their anatomical and anthropological features, disease (pathologies), traumas and medical manipulations that left traces on the bone remains. Stratigraphically, the graves date to the last phase of habitation of the medieval city (between the 30s/40s of the 11th c. and the 60s of the 11th c.). The newly studied graves can be placed in the context of the other intramural graves in the Inner City of Pliska, which makes it possible to clarify and summarize a wide range of issues related to the stratigraphy and chronology of the intramural graves and their connection with the demographic and ethnic cultural changes in the medieval city.

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Objectives: Despite the good prognosis of surgical treatment of chronic subdural hematomas, there are some early deaths, recurrences and post-operative complications. The objective of this study is to analyze the prognostic factors of chronic subdural hematomas in two reference university teaching hospitals in the city of Yaounde., Method: Three hundred and ten cases of chronic subdural hematomas were diagnosed on 3788 patients hospitalized in the neurosurgery departments of two reference university teaching hospitals in the city of Yaounde from January 1st, 2015 to December 31st, 2021 (7 years). The authors collected data from patients in whom surgical treatment was performed and assessed their prognosis with regard to the rate of early and late recurrence, mortality rate and postoperative complications and associated factors., Results: Data from 284 patients were analyzed. The mortality rate was 6.7 % and the recurrence rate was 3.2 % in early postoperative period and 4.5 % after a follow-up of 3-24 months. Prognostic factors for death were age greater than or equal to 80 years (p value = 0.034) and presence of cortico-subcortical atrophy (p value = 0.003). The main recurrence factors were age greater than or equal to 70 years and compartmentalization of the hematoma., Conclusion: Chronic subdural hematomas are generally of good prognosis when the Glasgow coma score on admission is good and adequate management is carried out as soon as possible. Advanced age, lesions such as cortico-subcortical atrophy and compartmentalization of the hematoma are all factors that predispose to recurrence or early mortality. Those groups of patients should therefore benefit from a closer follow-up in post-operative period., Competing Interests: Declarations of interest None., (Copyright © 2024 Elsevier B.V. All rights reserved.)

Abstract Background In a terror attack mass casualty incident (TerrorMASCAL), compared to a “normal” MASCAL, there is a dynamic course that can extend over several hours. The injury patterns are penetrating and perforating injuries. This article addresses the provision of material and personnel for the care of special injuries of severely injured persons that may occur in the context of a TerrorMASCAL. Methods To answer the research question about the preparation of hospitals for the care of severely injured persons in a TerrorMASCAL, a survey of trauma surgery departments in Bavaria (Germany) was conducted using a questionnaire, which was prepared in three defined steps based on an expert consensus. The survey is divided into a general, neurosurgical, thoracic, vascular and trauma surgery section. In the specialized sections, the questions relate to the implementation of and material and personnel requirements for special interventions that are required, particularly for injury patterns following gunshot and explosion injuries, such as trepanation, thoracotomy and balloon occlusion of the aorta. Results In the general section, it was noted that only a few clinics have an automated system to notify off-duty staff. When evaluating the data from the neurosurgical section, the following could be established with regard to the performance of trepanation: the regional trauma centers do not perform trepanation but nevertheless have the required material and personnel available. A similar result was recorded for local trauma centers. In the thoracic surgery section, it could be determined that almost all trauma centers that do not perform thoracotomy have the required material available. This group of trauma centers also stated that they have staff who can perform thoracotomy independently. The retrograde endovascular aortic occlusion procedure is possible in 88% of supraregional, 64% of regional and 10% of local trauma centers. Pelvic clamps and external fixators are available at all trauma centers. Conclusion The results of the survey show potential for optimization both in the area of framework conditions and in the care of patients. Consistent and specific training measures, for example, could improve the nationwide performance of these special interventions. Likewise, it must be discussed whether the abovementioned special procedures should be reserved for higher-level trauma centers.

The aim of this study is to describe four new cases of trepanation from the Great Hungarian Plain and complement two other previously published cases with new results from the 9th to 16th c. CE. Sex determination and age-at-death estimation were performed using classical macromorphological methods. In certain cases, radiographic imaging, 3D scanning, and radiocarbon dating were also performed. Our cases fit the formerly established understanding of trepanations, with a male majority and signs of trauma as accompanying symptoms. The cause of intervention was mostly therapeutic, i.e., trauma, in most cases. In order to simplify the currently confusing nomenclature in trepanation categories (complete–incomplete vs. surgical–symbolic), we propose the use of “trepanation” exclusively to all forms of intentional, non-violent removals of all three layers of the cranial vault. On the other hand, the phenomena widely known in Eastern Europe as symbolic trepanations should be designated as “cranioglyphs,” referring to all forms of superficial interventions administered to the cranial vault that do not penetrate all three layers of the bone. In case the data are insufficient to properly categorize the phenomenon at hand, one should refrain from it, and simply describe the lesion as intentional cranial intervention. In order to bring spotlight to the wide range of cranial interventions in the early medieval Carpathian Basin, our team is conducting several research projects, in order to contribute to a better understanding of these traditions in the future. [ABSTRACT FROM AUTHOR]

In this paper, the authors give a new insight to the indication and preparation of trepanations through the analysis of a newly discovered case of 10th‐century‐CE surgical trepanation found in the material of Sárrétudvari‐Poroshalom. We also intend to outline the implications of this particular case to the general methodology of trepanation research. We estimated basic anthropological data (sex and age‐at‐death) and performed analyses of paleopathological and activity‐related lesions. Computed tomography, radiocarbon, and genetic analyses were also conduced. Beside other prior traumas, two codependent lesions were detected on the right parietal bone with no sign of healing. In this lesion complex, an original sharp force trauma was observable surrounded by two curved, intentionally created furrows, which can be interpreted as attempted surgical trepanation presumably performed with a U‐shaped gouge. The results of the analysis of activity‐related changes and archeological examination corroborate the assumption that the injuries described on the skull may have been, indeed, acquired during activities connected to military lifestyle, and the individual may have been a high‐ranking military leader in his community. This unique case has paramount importance providing more detailed knowledge of past medical practices. The application of U‐shaped gouge has not been formerly documented in the literature, which opens a new perspective both in the osteological investigation of these interventions and the archeological research concerning ancient medical technology. Our results may suggest a possible mode of tool use, and aid future reconstruction attempts concerning the hypothesized 10th‐century‐CE trepan from Tiszaeszlár–Bashalom. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Background: Pneumocephalus is characterized by the presence of gas in the intracranial compartment, and it can be developed by trauma, craniofacial surgery or spontaneously. Clinical signs start within days or months after the injury and vary according to the site of involvement. Computed tomography is the ideal diagnostic tool, however skull radiography can also be used. Treatment varies according to the severity of the case, and it can be conservative or associated with surgical intervention in the most severe cases. The purpose of this report is to describe the case of a dog that developed pneumocephalus and suppurative meningoencephalitis after head trauma caused by a bite from another dog. Case: A 2-month-old bitch, mixed breed, with 3.2 kg, was referred to the Veterinary Hospital because it had been bitten on the head by another dog. Shortly after the incident, the animal showed no clinical signs. However, 2 days later, the bitch became depressed and in persistent lateral decubitus. A lesion with a crust of approximately 0.5 cm was found close to the occipital region, with bone irregularity on palpation. The animal was in lateral decubitus with muscular hypotonia, bilateral mydriasis unresponsive to light and stupor. Radiographic images showed parietal fracture and pneumocephalus. Based on the findings of physical and laboratorial exams, diagnosis of suppurative meningoencephalitis and pneumocephalus secondary to craniofacial trauma was established. Empirical broad-spectrum antimicrobial therapy was started in addition to mannitol, corticoids, and analgesics. The animal was referred for surgical debridement by trepanation, when samples were collected to bacterial culture, which was negative. Despites the care, the animal died 14 h after the surgical procedure. Histopathological examination of the frontal cortex was performed, being the histological changes compatible with suppurative meningoencephalitis. Discussion: Dog bites on the head and neck are particularly severe, and can create intracranial bleeding, disfigurement of the face, damage to peripheral structures or cranial fractures. In this report, through radiographic images, it was found that the patient had an intracerebral aerocele, since there was presence of gas in the intracranial compartment. This alteration should always be considered in animals with neurological alterations and a history of craniofacial trauma. The main neurological changes observed in the reported case were unresponsive to mydriasis and altered mental status 2 days after the trauma, and this delay in the onset of clinical signs is frequently reported in cases of pneumocephalus. Neutrophilia and leukocytosis observed can be justified by the suppurative meningoencephalitis, confirmed by the histopathological exam. Antimicrobial therapy should be started as soon as possible, and the choice must be based on their capacity to cross the blood-brain barrier and the broad spectrum. The administration of antibiotics before collecting the material for bacterial culture may explain the negative result of this test, so that it is not possible to determine whether the intracranial gas observed on the radiograph may have developed from the trauma or because of gas-producing bacteria. Head trauma can induce suppurative meningoencephalitis and pneumocephalus even in the absence of perforating wounds at the time of the consultation. The neurological signs can start days after the trauma. Besides the clinical and surgical treatments, the prognosis of any bacterial infection of the central nervous system is poor. [ABSTRACT FROM AUTHOR]

Trepanation refers to scraping, cutting, or drilling of an opening (or openings) into the cranium and is believed to be one of the earliest surgeries performed on and by man. Fossil evidence of trephined skulls has been found in separate continents throughout ancient history and such discoveries continue to be made even from geographic areas or time periods from which the practice was not previously known. Equally interesting is the evolution of this practice from ancient times to the modern neurosurgical era. This review seeks to define a framework around the history of cranial trepanation and tries to understand the various different interpretations of the origin and etiology of the art of cranial trepanation, starting in the prehistoric era. The contribution of ancient Indian medicine toward the progress of this branch of surgical expertise is also discussed. [ABSTRACT FROM AUTHOR]

Background: Craniotomy creates maximum aerosols threatening the health care workers (HCWs) of operation room. The technique of trepanation and measures to avoid complications has never been described in the literature. The time taken for craniotomy by different instruments has also never been compared. Methods: The study included only COVID-positive patients who underwent surgery. Craniotomy was performed using trephine, pneumatic/power drill (PD), and Hudson brace-Gigli saw (HB-GS). Trepanation as done in 32 patients. The generation of aerosols and time taken for craniotomy by these instruments was observed. The droplet spread over a waterproof graph paper of 10 × 10 sq. cm was calculated in 13 cases of all the three craniotomy methods. The technique of trepanation and maneuvers to overcome complications was discussed. Results: There was a gross difference in aerosol production and soiling of the surgical drapes, floor, surgeon's glove, gowns, face shield, goggles, etc. The average number of droplet aerosol in trepanation group was 4.76, 23.6 in drill and 21.3 in Gigli saw method. The average time taken for trepanation, PD, and HB-GS craniotomy was 4.8, 22.8, and 24.4 min, respectively. One mortality secondary to COVID was noted. All the HCWs assisting trepanation were negative for COVID-19 during postoperative follow-up of 7 days. However, 13 members of the surgical team which assisted in electric drill and HB-GS methods were COVID-positive. Conclusion: Trepanation should be the preferred method of craniotomy during COVID-19 pandemic as it is associated with the least aerosolization and is the most time efficient. [ABSTRACT FROM AUTHOR]

This research article explores the ancient origins of trepanation, unravelling its early instances and the associated cultural beliefs that have shaped cranial surgery. It scrutinises the medieval and Renaissance periods, elucidating the evolution of trepanation techniques within the context of advancements in medical knowledge and societal changes. In addition, the research investigates the diverse practices of trepanation across cultures, offering insights into the unique approaches, beliefs and rituals associated with this ancient surgical procedure. Examining the decline of trepanation in mainstream medicine, the article assesses the factors contributing to its diminishing prevalence and the emergence of alternative surgical methods. The study also delves into sporadic resurgences of trepanation in unconventional contexts, providing a nuanced understanding of its enduring fascination. In exploring trepanation's impact on modern medicine, the article sheds light on its contributions to the study of cranial anatomy, the evolution of surgical tools and the broader narrative of medical progress. Ultimately, this historical investigation contributes to a comprehensive understanding of trepanation, revealing the intricate interplay between medicine, culture and the human quest for knowledge and healing., Competing Interests: Declaration of conflicting interestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Background: In a terror attack mass casualty incident (TerrorMASCAL), compared to a "normal" MASCAL, there is a dynamic course that can extend over several hours. The injury patterns are penetrating and perforating injuries. This article addresses the provision of material and personnel for the care of special injuries of severely injured persons that may occur in the context of a TerrorMASCAL. Methods: To answer the research question about the preparation of hospitals for the care of severely injured persons in a TerrorMASCAL, a survey of trauma surgery departments in Bavaria (Germany) was conducted using a questionnaire, which was prepared in three defined steps based on an expert consensus. The survey is divided into a general, neurosurgical, thoracic, vascular and trauma surgery section. In the specialized sections, the questions relate to the implementation of and material and personnel requirements for special interventions that are required, particularly for injury patterns following gunshot and explosion injuries, such as trepanation, thoracotomy and balloon occlusion of the aorta. Results: In the general section, it was noted that only a few clinics have an automated system to notify off-duty staff. When evaluating the data from the neurosurgical section, the following could be established with regard to the performance of trepanation: the regional trauma centers do not perform trepanation but nevertheless have the required material and personnel available. A similar result was recorded for local trauma centers. In the thoracic surgery section, it could be determined that almost all trauma centers that do not perform thoracotomy have the required material available. This group of trauma centers also stated that they have staff who can perform thoracotomy independently. The retrograde endovascular aortic occlusion procedure is possible in 88% of supraregional, 64% of regional and 10% of local trauma centers. Pelvic clamps and external fixators are available at all trauma centers. Conclusion: The results of the survey show potential for optimization both in the area of framework conditions and in the care of patients. Consistent and specific training measures, for example, could improve the nationwide performance of these special interventions. Likewise, it must be discussed whether the abovementioned special procedures should be reserved for higher-level trauma centers. [ABSTRACT FROM AUTHOR]

This study aims to place trepanation in a medieval therapeutic context by addressing its medical use in neurological disorders and by testing the existence of particular dietary care for the sick. Six cases of trepanation found at the St. Cosme priory (La Riche, France) dated from the 12th-15th centuries. Neurological health was explored by geometric morphometrics by comparing the six cases to 68 skulls and 67 endocraniums belonging to individuals from the same period and geographical area. Trepanned diet was investigated by carbon and nitrogen isotopes and compared to 49 individuals from the same site. The study of shapes suggests a possible pathological state for four subjects. The diet of the trepanned is not different from the rest of the population. The treatment of neurological disorders emerges as the main therapeutic motivation in the corpus, contrary to the reports from the ancient surgical treatises. A specific diet for the sick is not highlighted. Geometric morphometrics is rarely used in paleopathology and the results suggest a potential of this type of analysis in the identification of pathological cases. The results on therapeutic motivations and diet do not fit the descriptions from ancient medical sources. The study of forms did not lead to definitive diagnosis. The isotopic study does not allow us to appreciate all the aspects of the diet. : A geometric morphometric study of the skulls and endocraniums of individuals with a known neurological condition would allow a better appreciation of the link between shapes and pathologies. [ABSTRACT FROM AUTHOR]