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The following images are of a study conducted to examine a trepanation case from an individual in a cemetery located along the ancient Silk Road in China. This dates back all the way to the Early Iron Age¹. The skull itself belongs to a middle-aged man and is suspected to have endured some sort of inflicted trauma or fracture near the right parietal bone. The process of surgical trepanation was most likely used to treat this; however, the lack of healing at the incision indicated immediate death during or after the procedure¹.

Overall, this evidence gives way to the idea of how widespread the use of trepanation was - even in early Western China. Many believed in trepanation's ability for neurological purposes, as well as trusting local physicians and surgeons' skillfulness to do so; therefore, indicating how common and popular this procedure was - on a global scale.

Source:
(1) https://novoscriptorium.com/2019/08/02/trepanation-in-ancient-china-2/

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Trepanation, when described, can easily sound like a dangerous and threatening procedure. Yet, it was so commonly practiced for thousands of  years- from Ancient Greece to pre-Colombian Peru¹. This trepanned skull above is of an individual who lived in Peru between 400 and 200 B.C.E. He endured a skull fracture that was treated with trepanation; however, he died less than 2 weeks later¹.

A study conducted by David Kushner, along with John Verano and Anne Titelbaum, sought to examine trepanation's success rate across different cultures and time periods. Around 59 skulls from Peru's southern coast to central highlands were inspected on the basis of the skull's healing capacity post-trepanation.  While only 50% of the earliest group survived, the numbers only increase from there. The next group's numbers were 53%, followed by 75% to 83% during the Inca period¹. These numbers are quite astonishing, due to the limited scope of instruments and discoveries of these historical time periods. However, it still goes to show the skill, techniques, and expertise of the people conducting these trepanations¹.

Source:
(1) https://www.science.org/content/article/south-america-s-inca-civilization-was-better-skull-surgery-civil-war-doctors#:~:text=But%20trepanation%E2%80%94the%20act%20of,subjects%20of%20the%20Inca%20Empire.

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To what can one owe the success rate and skill of trepanation? A big part of it has to do with the instruments used to carry out the procedure, especially in older times. To remove a section of from the skull, trepanning braces and trephines were common instruments used. Trepanning braces were first introduced in the 1500s. For use, one would have to use two hands where one hand would crank the handle.
However, by the 1700s, these braces were largely replaced by trephines¹. The trephine's design continued to be modified based on ease of use and procedure by surgeons. Even in present day, trephines are still used for therapeutic purposes on the skull².

Source:
(1) https://library.jefferson.edu/librarynews/index.php/2014/07/29/medical-instruments-in-the-archives/#:~:text=Answer%3A%20Trepanning%20braces%20and%20trephines,and%20treat%20headaches%20and%20epilepsy.
(2)
https://onlinelibrary.wiley.com/doi/full/10.1111/j.1365-2141.2007.06749.x

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19th century use of Neolithic trepanation

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19th century use of Neolithic trepanation

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Trepanation can feel like a bizarre practice; however, there is no denying the widespread use spanning different cultures and time periods. This includes more recent centuries: the 19th century.
Dr. Thomas Wilson Parry was a British surgeon who was intrigued by trepanning, especially in regard to the methods and tools used¹. Well into the early 20th century, he performed his own trepanning experiments on skulls using instruments that would be commonly present in Neolithic tribes (flint, glass, shell, obsidian, etc) ¹.
Parry was able to identify four main methods of ancient trepanation: scraping, boring, drilling, and sawing in straight lines to lift out a piece of skull. According to Parry, the latter, which was most common in Ancient Peru, was thought to be the most difficult.

Post-experimentation, he recorded that his average time to perform a trepanation through the scraping method was around half an hour. He concluded that his favorite tool for trepanning skulls was the shark tooth¹!

Sources:
(1) https://museumcrush.org/the-nineteenth-century-doctor-who-practiced-neolithic-trepanation/

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Trepanation seems to not be limited to being a solution for neurological disorders. Many claim that the procedure is also a method of expanding consciousness. In the 1960s-70s, trepanation had seen a surge with those who seemed to be interested in consciousness and psychedelic drug culture¹. Individuals like Amanda Feilding and Joe Mellen were involved with auto-trepanation (trepanning your own self) in attempts to "expand the mind" and "augment their consciousness." They both claimed physiological/psychological benefits¹.
A study conducted by professor Yuri Moskalenko looks more into the medical benefits of trepanation¹. He determined that trepanation caused the pulse stroke volume of the skull (or the amount of blood entering the skull after every heartbeat) to increase 8-10% on average. This increase causes more oxygen and metabolites (glucose) to enter the brain, which also increases the brain's processing power. Pressure reductions, as a result from a flexible skull, also can result in physiological effects.

Source
(1) https://thetartan.org/2016/4/11/scitech/trepanations#:~:text=Beyond%20the%20medical%20community%2C%20trepanation,and%20other%20psychedelics%20trepanned%20themselves.

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Awake Craniotomy for the Resection of Oligodendroglioma 

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Awake Craniotomy for the Resection of Oligodendroglioma 

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Maybe you're wondering "Well, do modern-day trepanation procedure exist?" Yes, in a sort of way they do! Currently, doctors perform called a craniotomy, a procedure that involves removing a section of the skull to visibly obtain access to the brain². While it is very similar to trepanation, there is one big difference. Unlike trepanation, craniotomies involve surgeons putting a bone fragment back onto the exposed skull. Trepanation involves leaving the drilled skull as it is as healing skin grows over it. Craniotomies can be useful for many neurological problems, especially for brain tumor removal¹.
The craniotomy being performed above is of Mr. S, a 61 year old male who had been suffering from a oligodendroglioma (a type of glial brain tumor) and received a craniotomy as a treatment option¹. The spectacular part of his procedure was the aspect of having an "awake surgery." This means that he was completely conscious and aware while the surgery was being conducted.
What benefit does this have? Well, the brain is a sensitive area to work with and it can be fairly easy to damage certain processing areas of the brain. Keeping a patient awake in this scenario can allow surgeons to not only maximize the tumor resection, but also minimize damage in the region of the brain where the tumor resides. Mr. S was not only having a craniotomy performed, but was also simultaneously going through intraoperative speech mapping to ensure minimal contact with the speech processing region of his brain¹.
It is really interesting to see how trepanation is still very applicable to the medical field in today's time, especially when we run through the time span it has been practiced. Trepanation has played a big role in shaping the way neurological procedures have evolved, and how we have been able to provide such procedures for life-threatening ailments like cancer.

Source:
(1) https://www.pennmedicine.org/for-health-care-professionals/for-physicians/physician-education-and-resources/clinical-briefings/2018/may/awake-craniotomy-clinical-briefing
(2) https://www.urmc.rochester.edu/neurosurgery/services/traumatic-brain-injury/craniectomy.aspx

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Galen of Pergamon would be a great fit to guide you through this exhibit! He is considered to be one of the most prominent medical writers in ancient Greek times, with his work influencing the evolution of medicine and anatomy until now1 . Galen was born in Pergamon in 129 B.C. and trained in medical school to eventually be a renowned physician and surgeon. As a physician, he practiced medicine on gladiators - which gave him better knowledge on anatomy, physiology, and treatment. All of this had a significant impact on the original work he produced.

Trepanation was still a common practice throughout Medieval Europe, and a lot of the instructions and principles were written by both Galen and Hippocrates¹. In fact, Galen actually improved trepanation techniques and defined its use, which made its use more widespread¹. He also contributed immensely to the nervous system, with contributions in anatomical structures like the corpus callosum, fornix, tectum, and much more. Not restricted to anatomy, Galen studied and advanced in several different aspects of medicine. Throughout his years, he produced overall 500 lectures, books and treatises¹.

Source:
(1) https://thejns.org/focus/view/journals/neurosurg-focus/23/1/foc-07_07_e11.xml