Cranial trephination in ancient Iran: case illustration

We present a trephinated skull4,5 dating from 2800 B.C. that was
recently uncovered during a mass grave excavation in Shahr-i Sokhta
(“Burned City”). This ancient city (3200–2000 B.C.) was situated
in the hills of southeastern Iran. The skull, 51 cm in circumference,
belonged to a 13- or 14-year-old girl4 (Fig. 1) and is now displayed
at the National Museum of Medical Sciences History of Iran. The
specimen has abnormally elongated cranial sutures, perhaps due to
hydrocephalus.5 Around the triangular hole carved into the right parietal
bone there is evidence of bone tissue regeneration, indicating
that the child may have survived for 6 to 9 months after trephination.
It is unclear whether the child died of a postoperative infection or
other causes.

Trephination was performed in many parts of the ancient world
and remains in use today in some traditional communities.1 Authors
of comparative osteology studies2 have demonstrated that using primitive
stone or metal instruments, prehistoric surgeons achieved an
average survival rate of 50 to 90% in patients undergoing craniectomy,
with little evidence of infection or other complications. The high
incidence of right parietal holes among ancient trephination specimens
may be due to that area’s easier accessibility to the right-handed
technician.1,3 The discovery of this skull does not strengthen our
understanding of why such procedures were performed or what anesthesia
and hemostasis techniques the ancients may have used, but
does provide evidence that trephination was used in ancient Iran with
methods similar to those of other civilizations.