@article{2992848,
    title = "Trepanations in the ancient Greek colony of Akanthos: Skull surgery in the light of Hippocratic medicine",
    author = "Aidonis, A. and Papavramidou, N. and Moraitis, K. and Papageorgopoulou, C.",
    journal = "International Journal of Paleopathology",
    year = "2021",
    volume = "35",
    pages = "8-21",
    publisher = "ELSEVIER SCIENCE INC 360 PARK AVE SOUTH, NEW YORK, NY 10010-1710 USA",
    issn = "1879-9817",
    doi = "10.1016/j.ijpp.2021.07.008",
    keywords = "female;  Greece;  head;  human;  male;  meta analysis;  paleopathology;  skull;  skull surgery, Female;  Greece;  Head;  Humans;  Male;  Paleopathology;  Skull;  Trephining",
    abstract = "Objective: The study presents seven new cases of trepanations on four individuals from the ancient Greek colony of Akanthos (5th - 1st c. BC) and juxtaposes the paleopathological observations with the Hippocratic treatises. Materials: A meta-analysis of 42 published trepanations on 27 individuals from Greece. Methods: Trepanations from Akanthos were observed macroscopically, stereoscopically and by computer tomography. The meta-analysis considers the demographic, geographical and temporal distribution, the techniques, associated pathology, and survival rate. Results: Trepanations were observed on four females in Akanthos. Three trepanations were performed with scraping and four with drilling. Two individuals exhibited significant signs of healing, and two survived shortly after the operation. In two cases, trepanation was practiced for treating cranial injuries. In Greek antiquity trepanation was performed predominantly in males, principally as a surgical treatment of cranial injuries. The survival rate was 62.9 %. Scraping was the oldest, most frequent and successful technique. Conclusions: Trepanation performed systematically in Greece since the Bronze Age (ca. 2,000 BC). Hippocrates who rationally conceived medicine, codified the pre-existing empirical knowledge. The trepanations from Akanthos show technical similarities but also discrepancies from the Hippocratic recommendations, confirming the mental and technical readiness of the ancient surgeon. Significance: The synchronous to Hippocrates trepanations from Akanthos, provide the opportunity to compare physical evidence with the written sources. Limitations: The frequency of trepanations is affected by the representativeness and the state of the skeletal preservation. Suggestions for future research: Trepanations published in previous decades, need to be reassessed with new imaging modalities. A standard recording methodology is fundamental for data comparison. © 2021 Elsevier Inc."
}