[The mystery of prehistoric trepanations: Is neurosurgery the world eldest profession?]

Trepanation is known to be the first surgical procedure ever performed. Its origins date from the Neolithic Age in Europe and the operation was particularly performed in South America at the Pre-Colombian era, a few thousand years later. Based on many archeological studies on trepanned skulls, we compare the differences and similarities of these two periods through epidemiological, topographical, and technical approaches. Signs of bony regeneration are assessed in an attempt to understand the postoperative survival of trepanned patients. The literature in surgery and archeology does not mention the possible relation between trepanations and growing skull fractures. However, it is reasonable to think that these cranial holes, occurring after a pediatric skull fracture, could mimic real trepanation orifices. The possible connections between these two entities are discussed. The etiological hypotheses on prehistoric trepanation are reviewed.