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Kunstformen der Natur (1904) by Ernst Haeckel
Kunstformen der Natur (1904) by Ernst Haeckel

Trepanning, also known as trephination, trephining or making a burr hole, is a medical intervention in which a hole is drilled or scraped into the human skull, exposing the dura mater in order to treat health problems related to intracranial diseases. It may also refer to any "burr" hole created through other body surfaces, including nail beds. It is often used to relieve pressure beneath a surface. A trephine is an instrument used for cutting out a round piece of skull bone.

Evidence of trepanation has been found in prehistoric human remains from Neolithic times onward. Cave paintings indicate that people believed the practice would cure epileptic seizures, migraines, and mental disorders. The bone that was trepanned was kept by the prehistoric people and may have been worn as a charm to keep evil spirits away. Evidence also suggests that trepanation was primitive emergency surgery after head wounds to remove shattered bits of bone from a fractured skull and clean out the blood that often pools under the skull after a blow to the head. Such injuries were typical for primitive weaponry such as slings and war clubs.

There is some contemporary use of the term. In modern eye surgery a trephine instrument is used in corneal transplant surgery. The procedure of drilling a hole through a fingernail or toenail is also known as trephination. It is performed by a physician or surgeon to relieve the pain associated with a subungual hematoma (blood under the nail); a small amount of blood is expressed through the hole and the pain associated with the pressure is partially alleviated.

Guillaume Apollinaire underwent a trepanation for medical reasons in 1906.

Voluntary trepanation

Although widely considered today to be pseudoscience, the practice of trepanation for other purported medical benefits continues. Moreover, some proponents point to recent research on the increase in cranial compliance following on trepanation, with resulting increase in blood flow, as providing some justification for the practice. Individuals have practiced non-emergency trepanation for psychic purposes. A prominent proponent of the modern view is Peter Halvorson, who drilled a hole in the front of his own skull to increase "brain blood volume".

The most prominent folk theory for the benefits of self-trepanation is offered by Bart Huges – alternatively spelled Bart Hughes and sometimes called "Dr. Bart Hughes", although he did not complete his medical degree. Hughes claims that trepanation increases "brain blood volume" and thereby enhances cerebral metabolism in a manner similar to cerebral vasodilators such as ginkgo biloba. No published results have supported these claims.

In a chapter of his book, Eccentric Lives & Peculiar Notions, John Michell cites Huges as pioneering the idea of trepanation in his 1962 monograph, Homo Sapiens Correctus, which is most often cited by advocates of self-trepanation. Among other arguments, Huges contends that children have a higher state of consciousness and since children's skulls are not fully closed one can return to an earlier, childlike state of consciousness by self-trepanation. Further, by allowing the brain to freely pulsate Huges argues that a number of benefits will accrue.

Michell quotes a book called Bore Hole written by Joey Mellen. At the time the passage below was written, Joey and his partner, Amanda Feilding, had made two previous attempts at trepanning Mellen. The second attempt ended up placing Mellen in the hospital, where he was reprimanded severely and sent for psychiatric evaluation. After he returned home, Mellen decided to try again. He describes his third attempt at self-trepanation:

After some time there was an ominous sounding schlurp and the sound of bubbling. I drew the trepan out and the gurgling continued. It sounded like air bubbles running under the skull as they were pressed out. I looked at the trepan and there was a bit of bone in it. At last!

Feilding also performed a self-trepanation with a drill, while Mellen shot the operation for the film Heartbeat in the Brain, which has since been lost. Portions of the film can be seen, however, in the documentary ''A Hole in the Head.

Michell also describes a British group that advocates self-trepanation to allow the brain access to more space and oxygen. Other modern practitioners of trepanation claim that it holds other medical benefits, such as a treatment for depression or other psychological ailments. In 2000, two men from Cedar City, Utah were prosecuted for practicing medicine without a license after they performed a trepanation on an English woman to treat her chronic fatigue syndrome and depression.

In popular culture

In a detail from "The Extraction of the Stone of Madness", a painting by Hieronymus Bosch (c.1488-1516), a trepanation is performed, see stone of madness.

  • In the movie Master and Commander: The Far Side of the World a trepanation is performed on a crew member by the ship's doctor, with the hole filled by using a coin.
  • In the movie π, the protagonist Max Cohen cures his migraines by performing a trepanation on his right temple.
  • In the movie Ghostbusters, Peter Venkman mentions that Egon Spengler had attempted self-trepanation prior to the events of the movie. Peter notes that Egon "tried to drill a hole through [his] head," to which Egon replies, "That would have worked if you hadn't stopped me."
  • In the episode Orison of the seventh season of The X-Files, reverend Orison is said to have drilled holes in his skull to boost his mental capabilities and so he could perform certain mental tricks one of which is called "stopping the world."
  • In the television series Dead Like Me, the character Mason, played by Callum Blue, died in 1966 by drilling a hole in his head to achieve "the permanent high."
  • In the television series Bones, Dr. Brennan and Mr. Zack notice a skull with an abnormal hole in it. They realize that the person had undergone trepanation before passing away.
  • In the episode "Live Show" of 30 Rock, Dr. Leo Spaceman has an informational brochure entitled "Trepanation" on his desk.
  • In the episode "Demons" of Stargate SG-1, A villager on a planet visited by Jack O'Neill is about to perform a trepanation on his niece.
  • In an episode of Grey's Anatomy, Izzie makes some "burr-holes" to save a man's life
  • In an episode of Rome, the character Titus Pullo requires the operation after a head injury sustained during a barroom brawl.
  • In an episode of House MD, Dr. House directs a mechanic at a research facility in Antarctica through the procedure to relieve the internal swelling in the facility doctor's head.
  • In the His Dark Materials series by Philip Pullman, trepanation is referenced as a method to draw Dust, the agent of human consciousness and creativity, to the trepanned person in greater quantity. The character Jopari underwent trepanation in becoming a shaman among the Tartars.
  • In the video game Fable III, a poster promoting the benefits of trepanning explains that it can stop "unclean" thoughts.
  • The Dance Gavin Dance album Happiness contains a song entitled "Self-Trepanation".
  • In the Japanese manga Homunculus, Susumu Nakoshi, the protagonist, has trepanation performed on himself for money. Afterwards, he finds that when he covers or closes his eye he can see a person's homunculus.

See also

Unless indicated otherwise, the text in this article is either based on Wikipedia article "Trepanning" or another language Wikipedia page thereof used under the terms of the GNU Free Documentation License; or on research by Jahsonic and friends. See Art and Popular Culture's copyright notice.

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