• Alexey L Krivoshapkin, Tatiana A Chikisheva, Alisa V Zubova, Vladislav P Kurbatov, Anatoli T Titov, and Pavel V Volkov.
• Meshalkin Novosibirsk State Research Institute of Circulation Pathology, Novosibirsk, Russia; Novosibirsk State Medical University, Novosibirsk, Russia.
• World Neurosurg. 2014 Nov 1;82(5):e649-55.

ObjectiveTo report the analysis of 3 cases of ancient trepanation discovered in the craniological collection (153 skulls) of the Pazyryk nomadic culture (500-300 bc) from the Gorny Altai, Russia, and to evaluate the technique, instrumentation, and materials used for cranial surgery as well as the motivation for the trepanations in Scythian times.MethodsA multidisciplinary approach was chosen to study the trepanned skulls. Visual inspection and examination under magnification, multislice computed tomography, high-field magnetic resonance imaging, and coupled plasma mass spectrometry and synchrotron radiation-induced x-ray fluorescence analysis of the bone samples from the site of trephination were used.ResultsIn the Pazyryk culture, trepanation was very likely used to perform the intracranial procedures that were not yet indicated by Hippocrates. No signs of bone infection were detected. Higher copper abundance found at the site of trepanation showed that a bronze knife was the most likely tool used by Scythian surgeons.ConclusionsOur data suggest that the Scythian population of the Altai Mountains had sufficient medical knowledge to perform sophisticated and successful manipulations on the human skulls. Scraping technique with bronze tools was quite effective for prevention of wound infection and resulted in a high survival rate after surgery. In the era of methicillin-resistant Staphylococcus aureus, it may be useful to consider some ancient surgical technologies.Copyright © 2014 Elsevier Inc. All rights reserved.

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