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"And just like in ancient Peru, we continue to advance our neurosurgical techniques, our skills, our tools, and our knowledge." Top image: More ancient skulls bearing evidence of trepanation - a tell-tale hole surgically cut into the cranium - have been found in Peru than the combined number found in the rest of the world.Credit: University of Miami Trepanation – the technique of removing bone from the skull by scraping, sawing, drilling or chiselling – has long fascinated those interested in the darker side of medical history. The leprechaun is perhaps one of the best-known creatures in Irish folklore.

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The researchers gauged survival by classifying the extent of bone remodeling around the trepanned holes, which indicates healing.

If there was no evidence of healing the researchers assumed the patient died during or within days of the surgery.

Which is why Verano devoted an entire book, It's also why Kushner, a medical history buff and Tulane alumnus, jumped at the chance to join Titelbaum in co-authoring one of the book's chapters, "Trepanation from the Perspective of Modern Neurosurgery," and continues to research the subject.

Published in 2016, the book analyzes the techniques and survival rates of trepanation in Peru through the demise of the Incan Empire in the early 1500s.

Physical evidence definitely shows that these ancient surgeons refined the procedure over time.

Their success is truly remarkable." Almost as remarkable is how, by the end of World War I, cranial surgery evolved into the distinct profession of neurosurgery, which continues to improve our understanding of brain anatomy, physiology and pathology.If the margins of the trepanation openings showed extensive remodeling, they considered the operation successful and the patient long-lived.Those classifications, Kushner, Verano and Titelbaum reported in the paper, show how ancient Peruvians significantly refined their trepanation techniques over the centuries."There are still many unknowns about the procedure and the individuals on whom trepanation was performed, but the outcomes during the Civil War were dismal compared to Incan times," said Kushner, a neurologist who has helped scores of patients recover from modern-day traumatic brain injuries and cranial surgeries."In Incan times, the mortality rate was between 17 and 25 percent, and during the Civil War, it was between 46 and 56 percent. The question is how did the ancient Peruvian surgeons have outcomes that far surpassed those of surgeons during the American Civil War?Those advertisers use tracking technologies to collect information about your activity on our sites and applications and across the Internet and your other apps and devices.

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