Jürgen Piek

Stone age skull surgery in Mecklenburg-Vorpommern: a systematic study.

OBJECTIVE Trephination of the cranial vault is the oldest known surgical procedure and has often been reported in the literature. The present study was performed to study the incidence, the techniques used, and possible indications for trephinations in the region of Mecklenburg-Vorpommern, the most northeastern German state. METHODS One hundred thirteen of a total of 115 Neolithic (c. 2000-3500 BC) skulls and eight smaller skull fragments found in the region of Mecklenburg-Vorpommern were examined. Defects and abrasions were detected in 31 of these skulls and underwent further examination (careful microscopic and/or endoscopic examination, three-dimensional computed tomography, and x-rays). RESULTS Six skulls showed defects resulting from trephination, mainly located along the midline or in the left parieto-occipital region. There was good osteological evidence that at least five of these operations had been survived. Two different techniques for trephination (circular cuts and scraping) had been used. CONCLUSION From the present study, we conclude that the incidence of trephination in Neolithic skulls in our region is at least 5% and that these operations had been survived in singular cases. There is increasing evidence that these procedures were intended to be curative.

The Frequency, Antecedent Events, and Causal Relationships of Neurologic Worsening Following Severe Head Injury

Neurologic deterioration observed following head injury is recognized as having a deleterious effect on outcome. The present study examines this occurrence in detail to determine the frequency of these episodes, their antecedent events and causal relationships in order to identify patients who are at risk. Data was collected prospectively from a consecutive series of 427 patients entered into the international trial of the NMDA receptor antagonist Selfotel. Using a definition of neurologic worsening based upon objective criteria, 117 patients were identified who suffered 164 episodes of deterioration. The occurrence of a single episode of neurologic worsening increased mortality by more than five-fold and reduced favorable outcomes (good or moderate on the Glasgow Outcome Scale), by more than 50%. Increased intracranial volume resulting in intracranial hypertension was the single most frequent cause of neurologic worsening. This serves to emphasize the importance of more adequate treatments of intracranial hypertension in improving the outcome of patients with severe head injury.