Team reconstructs 3,000 year old brain surgery

A 3,000 year old skull discovered last year in the Krasnoyarsk region of Russian allowed a team of scientists to determine how brain surgery would have been performed during the Bronze Age, according to reports published by the Daily Mail and the Siberian Times.

The skull, which was found in the Nefteprovod II burial ground at the Anzhevsky archaeological site southeast of Kansk, belonged to a male patient who died between the ages of 30 and 40, said Dr. Sergey Slepchenko of the Institute of Archaeology and Ethnography in Novosibirsk.

Dr. Slepchenko, who was previously a surgeon, explained that the skull contained markings that are believed to be from a surgical procedure and not related to ritualistic practices. Among those signs were an opening with evidence of bone healing on his left parietal bone, as well as signs of an inflammatory reaction on the bone plates themselves, according to the Times.

Those markings suggest that the man underwent a surgical procedure known as trepanation, in which a hole is made in the skull, exposing the “dura mater” layer in order to improve the brain pulsations. Long-term post-operative inflammation is believed to be the man’s cause of death.

Cannabis, ecstatic dancing used in place of anesthetic, pain killers

In lieu of an anesthetic, the patient was likely given mind-altering substances such as cannabis or magic mushrooms, and even ecstatic dancing might have been used to help him enter an “altered state of mind” during the lengthy procedure and to dull the pain, according to the Daily Mail.

The man, who was part of an unidentified ancient culture similar to the Karasuk people (but who was not one of them), is far from the first trepanation patient ever discovered in the region, noted Dr. Slepchenko; in fact, earlier work has found some that date back to the Neolithic period. Even so, the newfound skull scientists with a rare window into early brain surgery practices.

“For the preparatory phase of the operation, we can only use our best guess,” Dr. Slepchenko told the Times. “However, based on the shape and type of inclination of the edges, we may infer that the patient lay in a supine position with the head turned to the right. The surgeon probably stood face-to-face to the patient on the left side. Or the surgeon may have fixed the head with his left arm or between his knees and operated with his right hand.”

“While the surgeon made an incision, an assistant helped by stretching the skin at the edges of the wound, as well as passing instruments and other materials,” he added. He called it “likely” that “a wide cut to the bone through the skin and underlying tissues was performed,” and noted that “after the area was cut, the wound would have been opened to organize a ‘surgical field.’”

Doctors would have then removed the skin and tendon-like tissue to expose the bone underneath, which was then scraped. Changes to the bone that occurred during the healing process prevented the researchers from determining what kind of instrument was used, but judging from the shapes of the holes, they believe that it was some sort of scraper and not a knife.

Post-surgical complications likely led to the patient’s death

The scraping process would have continued until the dura mater was exposed, at which time the trepanation area could be widened, Dr. Slepchenko explained. Afterwards, the surgeons covered the opening with skin, and blood clots would have formed to prevent bleeding in the brain.

The wound “could not be too tight” to minimize infection risk, he noted. “It is not clear if sutures and/or bandages were applied; nor is it clear how the wound was drained. Yet some ethnographic records give evidence that these simple devices were implemented during trepanation.”

While the patient would have survived the procedure, odds are that post-surgical complications “such as wound abscess, meningitis, and brain abscess” ultimately led to his death after a period of time. Dr. Slepchenko and his colleagues have published a detailed reconstruction of what the early trepanation would have involved in the International Journal of Osteoarchaeology.

“The key to successful surgery was the patient’s complete trust and confidence that the surgeon had the necessary skills and knowledge to carry out such an operation,” he told the Times. While a traditional Karasuk-style knife was also found in his grave, Dr. Slepchenko said that there is no evidence that the instrument was actually used as part of the surgery.

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Image credit: The Siberian Times

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