Landmarks in the Traumatic Brain Injury

A Retrospective Study

Abstract

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As one might expect, prehistoric brain surgery lacked knowledge of the anatomy, concept recognition of the disease, and comprehension of the disease’s origin. Unfortunately, failure to deeply understand these important principles delayed the progression of medical and surgical practice. Trepanation may be one of the oldest surgical interventions for which archaeological evidence is present. In the 1990s, standardized guidelines were developed and established for the management of traumatic brain injury. They included protocols regarding the pharmaceutical therapy and the management of increased ICP. Since then, research has improved TBI survival. Evidence of trepanation practice and other techniques in pre-Columbian Mesoamerica is demonstrated by the cranial remains in pre-Columbian burials, iconographic artworks, and post-colonial reports. The intellectual understanding of neurosurgery developed during the golden age of ancient Greece where no surgeon restricted oneself in strict to neurosurgery. Head injuries on the other hand appear to have been abundant; an expected result of wars and internecine conflict, as recorded by Herodotus, Thucydides, and Homer. Then and now, war remains the primary source of study material for the improvement of knowledge regarding head injuries. Surgical procedures for the management of even minimal lesions of the theca cranica, continued throughout the 16 th and 17 th Century. The surgical technique, with cross-shaped skin incision and the instruments used (trephine, lever, scalpel, gouge, protector of the meninx, etc.) would remain unchanged with respect to the past, but one should take notice at the improved quality of the materials and the ameliorated precision with which the instruments were made. Some instruments appeared to be real work of art, as shown by the findings now displayed in museums and in illustrations of the times. The most ancient technique of craniotomy involved using abrasive instruments to thin down the bony wall. Subsequently, circular incisions were progressively made deeper, or a series of small holes were made in a circular fashion. The remaining bony bridges between these small holes would be broken down. The two latter methods that continued to be used for a very long period depended on using metal instruments.