Trepanning

Trepanning, also known as trepanation, trephination, trephining, or making a burr hole, is a surgical intervention in which a hole is drilled or scraped into the human skull. The intentional perforation of the cranium exposes the dura mater to treat health problems related to intracranial diseases or release pressured blood buildup from an injury. It may also refer to any burr hole created through other body surfaces, including nail beds. A trephine is an instrument used for cutting out a round piece of skull bone to relieve pressure beneath a surface.

History

Trepanning is one of the oldest known surgical procedures, dating back to the Neolithic period. Evidence of trepanning has been found in prehistoric human remains from various cultures across the globe. The procedure was performed for various reasons, including religious and mystical beliefs, as well as for medical purposes. In ancient times, trepanation was believed to cure ailments such as seizures, migraines, and mental disorders by releasing evil spirits trapped inside the skull.

Indications

In modern medicine, trepanning is performed for the following reasons:

• To relieve intracranial pressure due to traumatic brain injury or brain hemorrhage
• To evacuate a subdural or epidural hematoma
• To access the brain for biopsy or tumor removal
• To implant electrodes for deep brain stimulation in patients with Parkinson's disease or other movement disorders
• To treat certain cases of hydrocephalus by creating a new cerebrospinal fluid drainage pathway.

Procedure

Trepanning is typically performed under general anesthesia or local anesthesia with sedation. The surgeon makes an incision in the scalp and uses specialized instruments, such as a trephine or a high-speed drill, to create a hole in the skull. The size of the hole depends on the specific indication for the procedure. Once the necessary procedure is completed, the bone flap may be replaced and secured with sutures, plates, or screws. The scalp incision is then closed with sutures or staples.

Risks and complications

As with any surgical procedure, there are risks and potential complications associated with trepanning, including:

• Infection
• Bleeding or hematoma formation
• Damage to the brain or surrounding tissues
• Leakage of cerebrospinal fluid
• Seizures
• Adverse reactions to anesthesia

See also

• Craniotomy
• Skull fracture
• History of surgery
• History of medicine

References

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• WHO surgical instructions on burr holes
• Skeptic's Dictionary entry about Trepanation
• An illustrated history of trepanation
• Interview with self-trepanner Heather Perry
• ABC: A History of Craniotomy phisick.com 14 Nov 2011