[Trepanation of the skull in classical antiquity].

Archaeological findings prove that cranial operations of different techniques performed on living men, women, and children have a history of 7000 years. It is often assumed, that many of these operations were carried out for reasons, that are to be found in the realm of magic or, in the case of epilepsia, to drive the evil spirit out of the head. However, study of medical literature from classical antiquity proves that in those days medical doctors had a good knowledge of severe head injuries, as a result of their precise observation of injured or sick human beings. Consequently, there were a number of accurate medical diagnoses indicating cranial operations such as: severe fractures of the skull where cranial bones pressed upon the brain, haemorrhages between cranial bones and dura mater as well as osteomyelitis. The primary reason of surgical treatment of the latter was remove necrotic osseous tissue and not to trepan the skull. With the help of the surgical instruments found in Bingen and on the basis of sources from classical antiquity, the trepanation method as applied 2000 years ago may be explained in detail. Healing processes of skulls of people who underwent surgical treatment show that in an era where anaesthesia, asepsis and antibiotics were still unknown, approximately 80 per cent of patients survived the operation, provided that the highly elastic dura mater was not damaged either by the traumatic event or during surgery. An intact dura mater was the most important protection against infections which inevitably led to death in those times.