Trepanation

An automated trephine (trabecuphine) was used to perform an internal sclerectomy in seven glaucoma patients who were aphakic or had undergone previous filtering surgery that had failed or both. A patent fistula was achieved intraoperatively in all seven eyes. Postoperatively, six patients received subconjunctival injection of 5-fluorouracil (5-FU) once daily for an average of 8 days. Five of seven patients have retained a functional bleb and a controlled intraocular pressure (lOP) after surgery (follow-up, 4-24 months). The only intraoperative complication was hemorrhage from the sclerectomy site in a patient with aniridia that resulted in a 20% hyphema. The hyphema cleared quickly, and the bleb has remained functional with a pressure of 12 mmHg for 9 months. The trabecuphine makes it possible to perform a glaucoma filtering operation safely from within the anterior chamber. This technique minimizes conjunctival trauma in the filtration area. The absence of a conjunctival incision overlying the fistula simplifies the adjunctive use of antimetabolites such as 5-FU.

OBJECTIVE: To report the analysis of 3 cases of ancient trepanation discovered
in the craniological collection (153 skulls) of the Pazyryk nomadic culture
(500e300 BC) from the Gorny Altai, Russia, and to evaluate the technique,
instrumentation, and materials used for cranial surgery as well as the motivation
for the trepanations in Scythian times.
- METHODS: A multidisciplinary approach was chosen to study the trepanned
skulls. Visual inspection and examination under magnification, multislice computed
tomography, high-field magnetic resonance imaging, and coupled plasma mass
spectrometry and synchrotron radiationeinduced x-ray fluorescence analysis of the
bone samples from the site of trephination were used.
- RESULTS: In the Pazyryk culture, trepanation was very likely used to perform
the intracranial procedures that were not yet indicated by Hippocrates. No signs
of bone infection were detected. Higher copper abundance found at the site of
trepanation showed that a bronze knife was the most likely tool used by
Scythian surgeons.
- CONCLUSIONS: Our data suggest that the Scythian population of the Altai
Mountains had sufficient medical knowledge to perform sophisticated and
successful manipulations on the human skulls. Scraping technique with bronze
tools was quite effective for prevention of wound infection and resulted in a high
survival rate after surgery. In the era of methicillin-resistant Staphylococcus
aureus, it may be useful to consider some ancient surgical technologies.

Cranioplasty is one of the significant neurosurgical procedures in which the technical advances and also, by some means, drawbacks are still continuing. According to archeological findings and anthropological studies, the earliest procedures regarding cranioplasty date back to just about the same period claimed for trepanation. Ancient surgeons from different geographical sites and cultures performed both practices with remarkable survival rates. However, despite the length of the thriving past of cranioplasty, the first known written record on the topic dates back to late 16th century Europe. Further study of the Ottoman era documents revealed an intriguing text that was written about the repair of skull defects and that dates from early 16th century. This worthy discovery will add valuable contribution to the history of neurosurgery by drawing the written history of cranioplasty more than 60 years back and the use of organic grafts 160 years back. In the present study, this original text is discussed. D bIntelligence is the capacity of the brain to predict the future by analogy to the past,Q from the book On Intelligence by J. Hawkins.

Aiming to study the human skulls and their bones that showed surgical or cult practices, during the Neolithic era, a survey of known Portuguese cases was carried out, proceeding to an anthropological study and its con‑ textual framework, and the respective insertion the European Prehistory context. The study intends to treat the different cases of cranial bone use in its various variants or evidences of symbolic practice during the Neolithic period in order to provide the construction of new interpretations. Different cases of trepanation, skull discs and plaques, as well as masks obtained from the bones of the face will be presented.
Keywords: Cranial Analysis, Cranial Manipulations, Neolithic, Rituals.

Cranial manipulation from the neolithic necropolis of Feteira Cave - Portugal.
Neolithic necropolis in a karstic context, coming from the Portuguese Extremadura region, not far from the coast, from where it was possible to recover cranial facial mask and two evidences of trepanation. The facial mask was the first to be explicitly mentioned in the Portuguese archaeological bibliography.

Thirty-two skeletons from burial ground Bakheri chala were analysed macroscopically for pathological conditions such as trepanation, traumatic injuries, infectious disease and dental pathology. This study has shown that average age at death was relatively high. Trepanation with rectangular sawing for the first time found in the Armenia at two individuals. Trauma to the skull was common, which suggests a high level of inter-personal violence. We here report a case of decapitation. Bakheri chala site showed a high frequency of auditory exostosis. The dental pathology conditions of this population were numerous. Agriculture introduced people to carbohydrates, or sugars, which affect the teeth and cause dental caries. The staple diet of ancient population from Shnogh river consisted of wine, bread, vegetables, and fruits. Males do show a slightly higher rate of wear than females possibly suggesting a greater proportion of bread in the diet of males.

В статье рассмотрены черепа энеолитического периода с поселения Ботай в контексте проблемы происхождения древнего населения Казахстана. Авторами пересмотрены специфические особенности, выявленные ранее на одном из черепов и интерпретированные как признаки экваториального типа. На сегодняшний день данные особенности связывают с древнеуральской антропологической формацией, связанной с особым степным антропологическим типом, складывающимся в степной части Азии еще в нео-энеолитический период и зафиксированный на материалах ямной и последующей синташтинской культур.

This paper deals with the trepanned skulls from the early Iron Age found at
Smörkullen, Östergötland.
The conclusion to the reasons why the individuals were trepanned and how it happened was
because of something related to medicine or rituals. It is more likely that there were several
people who performed the trepanations than just one.

The paper presents craniological materials from the so-called «Cult barrow» or kurgan №36 from excavations
(fi eld 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 identifi ed the burials of diff erent
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.

Abstract:

L’argomento di questa tesi nasce dall'esperienza congiunta di rievocazione storica ed archeologia sperimentale che ho maturato con gli anni. Appassionato di rievocazione dal 2007,
ho praticato (e continuo tuttora a praticare) la scherma ed il reenactment relativi a svariati periodi della storia della Sardegna: il periodo medioevale (giudicale), quello romano-imperiale e da ultimo quello nuragico. La necessità di avere maggiori informazioni, non disponibili tramite le fonti scritte, iconografiche e archeologiche legate sopratutto a quest’ultimo periodo, mi ha portato con gli anni a pormi ulteriori quesiti sull’argomento. Quella dei nuragici era una società pacifica? In caso contrario come combattevano i suoi guerrieri? Che tipo di struttura gerarchico-militare avevano? Le risposte a queste domande diventavano sempre più impellenti man mano che mi confrontavo con il pubblico (e spesso con i pregiudizi legati a questo lontano periodo). Desideroso di avere delle risposte, coadiuvato dall’esperienza di artigiano-archeotecnico del bronzo che porto avanti nei ritagli di tempo, ispirato da studi sulla cosiddetta “archeologia del combattimento” e dalle tecniche forensi applicate nell'archeologia, sono giunto a conclusione che solo studiando i resti umani di quegli
uomini vissuti 3000 e più anni fa, avrei potuto ricavare maggiori risposte alle mie domande.
Nel presente lavoro ho esaminato i casi più noti in letteratura di reperti scheletrici con visibili segni traumatici, ponendo particolare attenzione ai periodi preistorici. Come paragone
per lo studio dei reperti nuragici è stato utilizzato lo scheletro di un presunto soldato medioevale, il quale presentava diversi traumi da combattimento. I resti ossei nuragici consistono in tre crani appartenenti a tre diverse sepolture collettive localizzate in aree della Sardegna tra loro molto distanti. Per questi tre casi si è provveduto a determinare il tipo di trauma osservato, che tipo di arma ha provocato la ferita e lo scenario ipotetico dell’aggressione che ha interessato ciascun individuo. Lo studio di questi casi ha permesso una ricostruzione delle modalità di combattimento più verosimili per tale periodo; queste hanno
permesso di dedurre quali ferite e in quali aree del corpo si potrebbero riscontrare più frequentemente i traumi. La riproduzione dei traumi mediante prove d’archeologia sperimentale (test di taglio) hanno permesso di capire quali lesioni potrebbero essere prodotte da alcune specifiche armi dell’età del Bronzo. Come ultima analisi sono stati elencati i principali casi di trapanazioni craniche per poter determinare se tali pratiche siano da mettere in relazione a traumi conseguenti ad episodi violenti o a pratiche etnoiatriche.

The subject of this thesis was born from a joint of historical reenactment and experimental archeology that I have gained over the years. Fond of living history since 2007, I practiced (and still continuing to practice) the fencing and the reenactment related to various periods of the history of Sardinia: the medieval period (Judicial), the Roman Empire and finally the nuragic one (Age of Bronze). The need to have more information, not available through the written sources, iconographic and archaeological related especially in the latter period, led me through the years to ask me more questions on the subject.
Nuragics was that of a peaceful society? Otherwise how his warriors fought? What kind of hierarchical-military had? The answers to these questions became more compelling as I compared them with the public (and often with the prejudices related to this distant period). Eager to get answers, aided by the experience of bronze artisan-archaeotecnic that I carry in my spare time, inspired by studies on the so-called "archeology of combat" and forensic techniques applied in archaeology, I have come to the conclusion that only by studying the human remains of those men lived 3000 years and more ago, I could get more answers to my questions.
In this paper I have examined the best known cases in the literature of skeletal remains with visible signs of trauma, paying particular attention to prehistoric times. As a comparison for the study of the nuragic finds, was used the skeleton of a supposed medieval soldier, who presented several combat trauma. The skeletal nuragic remains consist of three skulls belonging to three different collective burials located in areas of Sardinia each other very distant. For these three cases, it was decided to determine the type of trauma observed, what kind of weapon caused the wound and the hypothetical scenario of the attack that affected each individual. The study of these cases has allowed a reconstruction of how to combat the most plausible for that period; These have enabled us to deduce which wounds and in which areas of the body could be encountered more frequently trauma. Reproduction of trauma by tests of experimental archeology (test cutting) has allowed us to understand what injuries could be produced by a number of specific Bronze Age weapons. As the final analysis were listed the main cases of cranial drilling to determine whether such practices are to be related to trauma resulting from violent incidents or etnoiatric practices.

Le papyrus Edwin Smith, daté du XVI e siècle avant J.-C., dessine les premières ébauches de neuroanatomie et de neurochirurgie dans les sources écrites. Le corpus hippocratique, au V e siècle avant J.-C., marque la naissance de la littérature médicale et consacre un livre à l'anatomie et à la chirurgie crânienne. Dans la continuité de cette tradition littéraire, les chirurgiens du Moyen Âge ont produit de nombreux traités nous renseignant sur les modes opératoires et les visées thérapeutiques des interventions sur la boîte crânienne.

This case study describes a unique anthropogenic modification of two individual skeletons excavated from the pre-Columbian site of Kuelap, Chachapoyas-Amazonas, in the northeastern highlands of Peru. While numerous examples of cranial trepanations using an adjacent drilling technique have been recovered from this site and region, this is the first example of such a surgical technique on a post-cranial
element. Skeletal remains demonstrate that ancient Andeans were skilled and successful with many surgical treatments. Ethnohistoric documents suggest the Chachapoya shamans were known for their healing. In these cases, however, there is no evidence of  long-term healing. This innovative medical procedure appears to have been an attempt at therapeutic intervention intended to treat an osteomyelitic infection of the distal tibial metaphysis.

Symbolic trepanation is an invasive procedure, performed on living individuals, without creating a direct connection between the endocranial space and the outer world. Most cases of symbolic trepanation come from the archaeological discoveries made in the Carpathian Basin and in Bulgaria, dating from Early and Middle Age. For the space between Pruth and Dniester rivers, the first symbolic trepanations (14 cases / skulls) were discovered by I. Hîncu, in the medieval necropolises known as Căprăria (10 th-12 th centuries) and Limbari (12 th-14 th centuries). These skulls have one, two or three symbols located on the sagittal suture or in its proximity. In this paper, we propose to the scientific community of the domain four new symbolic trepanation cases, discovered in the space between Pruth and Dniester, namely in the medieval flat necropolis of Lozova-La hotar cu Vornicenii (Grave no.77), in the burial mound no.1 from Ciumai (Grave no.9), in the burial mound no.8 from Cimişlia (Grave no.5) and in the burial mound no.12 (Movila Gologan) from Crihana Veche (Grave no.7). Three skulls belonged to men of different ages and only one to a woman. Two of the four cases have one symbolic mark (on the frontal bone or in the bregma), the other two having two such marks (on the sagittal suture or on the parietal bones, without affecting the sagittal suture). The individuals with only one mark show Europoid features, while those with two symbolic signs on the skull have typologically mixed Europoid and Mongoloid features. Considering the symmetry of symbols, which is evident, we cannot reject their ritualic-symbolic role, probably related to the concept of body integrity changes. The purpose of such a method of body modification could be guided by a series of social and aesthetic standards or by a certain type of self-identification.

This chapter explores the role of skull-collecting, healing, and anthropology in the transnational Indigenous identity formation of Julio César Tello (1880-1947), a Peruvian archaeologist from the predominantly Indigenous region of Huarochirí. In the early 1900s, while training to become a surgeon in Lima, Tello saw that a set of trepanned skulls that his family collected in the early 1890s had traveled to Washington, D.C., joining the collections of the Bureau of American Ethnology. Trepanation is a cranial surgery whose prehistoric existence was gleaned because of Peruvian specimens, but whose medical purposes was denied by North American anthropologists. Newly alert to his family’s participation in hemispheric anthropology, as well as his own Indigenous scientific and pedigree, Tello devoted himself to trepanned skulls’ collection. After studying anthropology at Harvard, he made the case, internationally, that trepanation was indeed medical. This paper takes Tello’s early career as a vehicle for considering not only how Indigenous identities shaped anthropology, but also how anthropology shaped Indigenous anthropologists’ sense of self. It also foregrounds a Peruvian cultural relativism that, in contrast to that of Boas, involved a more permanent, and perhaps ethical, commitment to the Indigenous dead as both subjects and intellectual actors.

During the 1930’s Aleš Hrdlička excavated and published on human remains from numerous sites across Alaska, including five cases of trepanation from pre-Russian contact era (Hrdlička, 1941).  Trepanation is a surgical procedure involving the cutting, drilling, or scraping away of a bone’s cortex to produce a hole into the inner space, usually but not limited to, the cranial cavity.  This procedure was practiced in prehistory and continues to be utilized in modern trauma care to relieve intracranial pressure.  These Kodiak Island cases were used, in part, as a basis for inferring traditional methods of surgery among indigenous Alaska natives (Fortunine, 1985).  An additional case of possible trepanation was discovered on Attu Island (part of the Aleutian archipelago) by Alan May, one of Hrdlička’s trusted field hands.  While the Unangan people were known to have had special knowledge of anatomy and medical practices (Marsh and Laughlin 1956), May acknowledged in his field notes that, “such a case [of trepanation] has never been heard of from this district” (Veltre 2013:141).  Only one of Hrdlička’s cases and the May’s example are available for reappraisal; the other four individuals were repatriated in the 1990’s under the federal legislative requirements of the National Museum of the American Indian Act, the precursor to NAGPRA.  Detailed macroscopic examination of the extant cases, and previous documentation of the repatriated cases, revealed bone surfaces not consistent with the cut or scraped surfaces of trepanation from other cultures, calling into question whether the procedure was ever practiced in Alaska.

We present results of osteological and isotopic analyses of human remains from Cova de la Pastora (Alcoi, Alicante, Spain) and discuss the implications in light of a new sequence of radiocarbon dates indicating that the cave was used as a burial site in the Late Neolithic (ca. 3800e3000 cal BC), Chalcolithic (ca. 3000 e2500 cal BC), Bell Beaker Transition (Horizonte Campaniforme Transicional -HCT; ca. 2500e2200 cal BC) and the Bronze Age (ca. 2200e1500 cal BC). Similarities in stable isotopic values of C and N indicate little variation in subsistence between men and women, and a similar nutritional base from the Late Neolithic to the Bronze Age. This pattern of stability is augmented by evidence of trauma and disease found on numerous skulls in the collection. Since no clear associations of specific grave goods with certain individuals based on sex or age could be determined, the only suggestion of social inequality lies in the burial practice itself, where certain individuals were interred in caves while others were not.

Rebeca Esnaola Bermejo: La exposición “La vida impresa en los huesos. Paleopatología en Navarra”, presentada en el Museo de Navarra entre septiembre de 2019 y febrero de 2020, se asienta en la tradición y prestigio de la arqueología en Navarra y en su presencia en este museo. En esta ocasión las piezas arqueológicas se muestran bajo una óptica nueva, desde la paleopatología, que estudia las huellas que las enfermedades dejan en nuestros huesos. Cuando se dan las circunstancias apropiadas para la conservación de los restos óseos y los yacimientos se excavan de manera rigurosa, el análisis de estos restos nos ofrece mucha información sobre nuestro pasado, sobre la vida de nuestros antepasados. También nos invita a pensar en nosotros mismos, en nuestro cuerpo, y en aspectos como el progreso de la sanidad y los cuidados que dispensa el entorno más próximo. Este discurso novedoso encaja en el proyecto de renovación del Museo de Navarra, que propone nuevos relatos en torno a sus colecciones. La exposición reúne piezas de 27 yacimientos de 18 municipios de Navarra, algunas ya conocidas y otras no expuestas hasta ahora procedentes de excavaciones de los últimos años, incluida alguna de este mismo año. Cronológicamente oscilan entre el pasado remoto, como las piezas del tercer milenio antes de Cristo procedentes del dolmen de Aizibita y el Hipogeo de Longar, y principios del siglo XIX, como los restos de El Carrascal. Los restos óseos exhibidos pertenecen a hombres y a mujeres de edades diversas, desde una personita de tan sólo veinte semanas de gestación hasta un longevo hombre de más de sesenta años. Su presentación en las salas está acompañada de recursos museográficos que facilitan su comprensión. Esta publicación desea complementar la información que se ofrece en las salas y favorecer su difusión, más allá de la clausura de la exposición, entre el público general y los especialistas. La propuesta de este proyecto y su desarrollo, especialmente complejo, se debe a su comisaria, Patxuka de Miguel Ibáñez, doctora en Historia y matrona de profesión, a quien agradezco su esfuerzo.

Trepanations have been described from various locations around the world leading to a suggestion that this is a cultural practice that has widely diffused from one or two centres (1). In the UAE the earliest trepanations date to the Neolithic, significantly earlier than trepanations in surrounding areas. The discovery of at least two crania in Oman, dating apparently to the early third millennium and resembling in technique and placement trepanations from north India may be evidence of the diffusion of a therapeutic practice from the Gulf to the subcontinent. However, the lack of any trepanation among the numerous contemporary skeletons from Bahrain suggests that any diffusion has distinct limits and that, as anthropological work from the South Pacific (2) indicates, practices like trepanation are often heavily embedded in broader, culturally located explanatory models.

The goal of this study is to describe briefly two trepanned cranial specimens from a Spanish medieval archaeological site. One of them belongs to a mature male in which a grooving trepanation technique was used. The other is a mature female skull in which a scraping procedure was performed. The historical context of the individuals is assessed, as well as characteristics from both trepanations and evidence of survival after the intervention. In the female skull, signs of osseous regeneration can be observed, which imply survival after the operation. No survival signs can be found in the male skull. Possible causes that could have motivated the intervention are also discussed.

Symbolic or incomplete trephinations are very common in Hungary in 9 th-11 th century AD skeletal series connected to early Hungarians, although they also occur in the preceding Avar Age (6 th-9 th c. AD) material. During the compilation of a database of regional cranial modification data, the authors found rare almondshaped symbolic trephinations in both periods, while these had formerly only been reported in Early Hungarian series. In this study, the new almond-shaped lesions are described along with other symbolic trephinations of 14 newly found skulls from the 8 th-11 th centuries AD in the Southern Great Plain of Hungary. The authors review the research of the phenomenon. The new findings may strengthen the theory of direct and very close cultural connections of these two ethnic groups, adding a new aspect to the debate over the origin and relationship of Late Avar (late 7 th-early 9 th c. AD) and Early Hungarian (9 th-11 th c. AD) populations.

Curgical evidences in archaeological contetxs.
Aiming to study the human skulls and their bones that showed surgical or cult practices, during the Neolithic era, a survey of known Portuguese cases was carried out, proceeding to an anthropological study and its contextual framework, and the respective insertion the European Prehistory context.
The study intends to treat the different cases of cranial bone use in its various variants or evidences of symbolic practice during the Neolithic period in order to provide the construction of new interpretations.
Different cases of trepanation, skull discs and plaques, as well as masks obtained from the bones of the face will be presented.
The practice of using the human skull as a ritual object and subject to interventions and the consequent use of cranial bones is something that underlies a "way of thinking" added to the "explosion of the symbolic" that Jacques Cauvin refers (1997), and, acquiring another breath from the time the neolithic process begun in the Near East and epistolized during the PPNB as express by Kathleen Kenyon (1957), Jacques Cauvin (1997), or Mehmet Özdogan (1998), during which time we can find a greater expressiveness of use and manipulation of human cranial bones, that is, when the neolithic process begins to spread (Zilhão, 1992, 1993, 2000).
“For it is now recognized as important that many elements of life can be structured by religion, and can be archeologically recognizable as such […]” Archaeology, Ritual, ReligionTimothy Insoll (2004)

This paper synthesizes a much longer version in Spanish on Mesoamerican trephining techniques in comparison among cultural areas. Tiesler 2006 ¿Hubo trepanación en la antigua sociedad maya? Una apreciación regional. Antropología Física Latinoamericana 4:169-218.
A special thanks to Joel Skidmore for making this work available to the anglosaxophone readership.

Рассматриваются материалы курганов 4, 5 могильника Талды-2, курганов 1, 7 могильника Карашокы и кургана 1 могильника Акбеит. Эти памятники, для которых характерны большие размеры, сложная конструкция, наличие в могиле престижных изделий, датируются в рамках раннесакского периода —VII–VI вв. до н. э. Среди антропологических материалов из новых памятников тасмолинской культуры Центрального Казахстана обнаружены черепа с трепанациями, имеющимися, как правило, на затылочной части. По итогам анализа материалов отмечается, что подобные трепанации маркируют высокий социальный статус погребенного. Необходимость выполнения небольших отверстий в затылочной области черепа, вероятно, связана либо с введением консервирующего состава в полость черепной коробки для бальзамирования тела, либо с очищением скелета от мягких тканей в процессе хранения тела до времени погребения. Рассмотренные данные подтверждают наличие традиций специфической подготовки
тела к переходу в загробный мир, широко распространенных на территории Казахстана и Центральной Азии в древности. Для плодотворного исследования темы привлечены и этнографические материалы.

Two kinds of trephinations, surgical and symbolic, are found on the
osteological remains of ancient populations. In both cases a bony portion of the cranial vault is removed from the skull. Surgical trephination
creates communication between the cranial cavity and the environment;
it is mainly done for medical purposes. When a trephination is symbolic,
only the externel cortical layer (maybe together with the spongious part)
of the vault is removed; the reason of this intervention is always cultical.
The practice of trephining is known since very early times. Successful
surgical trepanations showing definite evidence of healing were found in
Bronze Age sediments in present-day Hungary and frequently occurred
till modern times. Symbolic trephination can be regarded as special pagan Hungarian custom in the Carpathian Basin, as it was introduced to
the area at the age of the Hungarian Conquest (896 A.D.). Its frequency rapidly decreased with the spreading of Christianity and disappeared
at the beginning of the 12th century. Materials and methods. Literature
survey and macroscopic analysis of osteological materials. Results. Five
new cases of trephination deriving from 10–11th century Hungarian populations are described.  Discussion and conclusions. On the basis of
these data we propose a new interpretation of techniques used for trephinations with irregular appearance. In connection with this, we also
present a possible explanation of the high frequency of survival among
the trephined Hungarians during the era of the Conquest.

Two kinds of trephinations, surgical and symbolic, are found on the osteological remains of ancient populations. In both cases a bony portion of the cranial vault is removed from the skull. Surgical trephination creates communication between the cranial cavity and the environment; it is mainly done for medical purposes. When a trephination is symbolic, only the externel cortical layer (maybe together with the spongious part) of the vault is removed; the reason of this intervention is always cultical. The practice of trephining is known since very early times. Successful surgical trepanations showing definite evidence of healing were found in Bronze Age sediments in present-day Hungary and frequently occurred till modern times. Symbolic trephination can be regarded as special pagan Hungarian custom in the Carpathian Basin, as it was introduced to the area at the age of the Hungarian Conquest (896 A.D.). Its frequency rapidly decreased with the spreading of Christianity and disappeare...