Chorney Michael A, Gandhi Chirag D, Prestigiacomo Charles J
Department of Neurological Surgery, Rutgers-New Jersey Medical School, Newark, New Jersey.
Neurosurg Focus. 2014 Apr;36(4):E7. doi: 10.3171/2014.2.FOCUS13563.
Craniotomies are among the oldest neurosurgical procedures, as evidenced by early human skulls discovered with holes in the calvaria. Though devices change, the principles to safely transgress the skull are identical. Modern neurosurgeons regularly use electric power drills in the operating theater; however, nonelectric trephining instruments remain trusted by professionals in certain emergent settings in the rare instance that an electric drill is unavailable. Until the late Middle Ages, innovation in craniotomy instrumentation remained stunted without much documented redesign. Jacopo Berengario da Carpi's (c. 1457-1530 CE) text Tractatus de Fractura Calvae sive Cranei depicts a drill previously unseen in a medical volume. Written in 1518 CE, the book was motivated by defeat over the course of Lorenzo II de'Medici's medical care. Berengario's interchangeable bit with a compound brace ("vertibulum"), known today as the Hudson brace, symbolizes a pivotal device in neurosurgery and medical tool design. This drill permitted surgeons to stock multiple bits, perform the craniotomy faster, and decrease equipment costs during a period of increased incidence of cranial fractures, and thus the need for craniotomies, which was attributable to the introduction of gunpowder. The inspiration stemmed from a school of thought growing within a population of physicians trained as mathematicians, engineers, and astrologers prior to entering the medical profession. Berengario may have been the first to record the use of such a unique drill, but whether he invented this instrument or merely adapted its use for the craniotomy remains clouded.
开颅手术是最古老的神经外科手术之一，早期人类颅骨上发现的颅盖骨洞就是证明。尽管器械在变化，但安全穿透颅骨的原则是相同的。现代神经外科医生在手术室经常使用电动 drills；然而，在罕见的情况下，如果没有电钻，非电动环钻器械在某些紧急情况下仍受到专业人员的信赖。直到中世纪晚期，开颅手术器械的创新一直停滞不前，没有太多有记录的重新设计。雅各布·贝伦加里奥·达·卡尔皮（公元 1457 - 1530 年）的《颅骨骨折论》描绘了一种在医学著作中从未见过的 drill。这本书写于公元 1518 年，是因洛伦佐二世·德·美第奇医疗过程中的失败而创作的。贝伦加里奥的带有复合支架（“vertibulum”）的可互换钻头，即如今所知的哈德逊支架，象征着神经外科和医疗工具设计中的一种关键器械。这种 drill 使外科医生能够储备多个钻头，更快地进行开颅手术，并在颅骨骨折发病率增加、因而对开颅手术需求增大的时期降低设备成本，而颅骨骨折发病率的增加归因于火药的引入。其灵感源于一群在进入医学领域之前接受过数学家、工程师和占星家培训的医生群体中逐渐形成的一种思想流派。贝伦加里奥可能是第一个记录使用这种独特 drill 的人，但他是发明了这种器械还是仅仅将其应用于开颅手术仍不明确。
