Neurosurgical aspects of trepanations from Neolithic times

Trepanation of the cranial vault is the oldest known surgical procedure and has often been reported in the literature. We present two skulls with trepanations from Neolithic excavations in southwestern Germany. One skull exhibits a healed fracture in association with the trepanation. Both skulls show clear signs of healing without evidence of osteolytic inflammatory reaction. We discuss conditions relating to survival from trepanation in Neolithic times and some potential complications such as intraoperative bleeding and wound infection, in the context of modern neurosurgical knowledge. We conclude that neolithic skull surgery was probably mainly extradural.