Legacies of Neurosurgery and its Implications on Global Neurosurgery Today

Trephination, the practice of boring a hole in the skull, is one of the oldest surgical procedures performed by and on humans. Fossil records show evidence of trephined skulls on separate continents throughout ancient history. Even more remarkably, fossils show that ancient humans actually survived the procedure, some more than once. Ancient mythologies and texts provide context to the fossil record, indicating that trephination was performed some of the time for medical indications, including traumatic head injury and intractable neurologic conditions. In the modern day, traumatic brain injury accounts for a significant percentage of the overall global burden of disease and its incidence is disproportionately increasing in low- and middle-income countries. In critical situations, neurosurgical intervention may be indicated. The burr hole procedure, or trephination, was identified as an essential surgical procedure that all first-level hospitals should be able to perform; however, there exists a dramatic lack of access to neurosurgical specialists and care globally, especially among low- and middle-income countries. Task-shifting/sharing is one paradigm that may be used effectively to broaden access to this life-saving procedure but it is at the moment a contested practice.