Kushner David S, Verano John W, Titelbaum Anne R
Department of Physical Medicine & Rehabilitation University of Miami Miller School of Medicine, Miami, Florida, USA.
Department of Anthropology, Tulane University, New Orleans, Louisiana, USA.
World Neurosurg. 2018 Jun;114:245-251. doi: 10.1016/j.wneu.2018.03.143. Epub 2018 Mar 29.
More prehistoric trepanned crania have been found in Peru than any other location worldwide. We examine trepanation practices and outcomes in Peru over nearly 2000 years from 400 BC to provide a perspective on the procedure with comparison with procedures/outcomes of other ancient, medieval, and American Civil War cranial surgery. Data on trepanation demographics, techniques, and survival rates were collected through the scientific analysis of more than 800 trepanned crania discovered in Peru, through field studies and the courtesy of museums and private collections in the United States and Peru, over nearly 3 decades. Data on procedures and outcomes of cranial surgery ancient, medieval, and during 19th-century through the American Civil war were obtained via a literature review. Successful trepanations from prehistoric times through the American Civil War likely involved shallow surgeries that did not pierce the dura mater. Although there are regional and temporal variations in ancient Peru, overall long-term survival rates for the study series were about 40% in the earliest period (400-200 BC), with improvement to a high of 91% in samples from AD 1000-1400, to an average of 75%-83% during the Inca Period (AD 1400s-1500). In comparison, the average cranial surgery mortality rate during the American Civil war was 46%-56%, and short- and long-term survival rates are unknown. The contrast in outcomes highlights the astonishing success of ancient cranial surgery in Peru in the treatment of living patients.
在秘鲁发现的史前开颅颅骨比世界上任何其他地方都多。我们研究了从公元前400年开始近2000年秘鲁的开颅手术实践及结果，以便与其他古代、中世纪和美国内战时期的颅骨手术程序/结果进行比较，从而对该手术有一个全面的认识。通过对在秘鲁发现的800多个开颅颅骨进行科学分析，以及近30年来通过实地研究并承蒙美国和秘鲁的博物馆及私人收藏机构的提供，收集了有关开颅手术的人口统计学、技术和存活率的数据。通过文献综述获取了古代、中世纪以及19世纪美国内战期间颅骨手术的程序和结果数据。从史前时期到美国内战期间成功的开颅手术可能涉及未穿透硬脑膜的浅手术。尽管古代秘鲁存在区域和时间差异，但该研究系列的总体长期存活率在最早时期（公元前400 - 200年）约为40%，在公元1000 - 1400年的样本中提高到了91%的高位，在印加时期（公元1400年代 - 1500年）平均为75% - 83%。相比之下，美国内战期间颅骨手术的平均死亡率为46% - 56%，短期和长期存活率未知。结果的对比凸显了古代秘鲁颅骨手术在治疗活体患者方面惊人的成功率。
