Linear cutting trepanation in Italy: a unique case from Hellenistic Sicily (3rd century BC)

During the archaeological excavations conducted in the Hellenistic necropolis discovered in Messina (Sicily, Italy) dating back to the 3rd century BC., a skeleton showing evidence of cranial traumas and surgical intervention was found. The skull, belonging to a young adult male, presented signs of four head injuries produced by both blunt and sharp-edged instruments. The first two lesions, located on the frontal bone, were produced by blunt blows and showed signs of long-time survival. The third lesion, located on the inferior portion of the right parietal, suggests a perimortem non-penetrating linear cut probably caused by a blade instrument. Finally, a rectangular bone loss is visible on the left parietal bone, involving the full cranial thickness with well-delimited cutting-edges and no sign of a reparative process. This injury can be interpreted as the result of a trepanation, performed with the technique defined as "linear cutting" and obtained through four linear incisions in parallel pairs intersecting at the right angles. The trepanation is probably related to the multiple head injuries exhibited by the patient, who unfortunately did not survive the surgical intervention. Trepanation in Italy has been largely attested since Prehistoric times, but the case from Messina represents the first evidence of neurosurgical intervention performed through the linear cutting technique in the Italian context and the second case in the whole of Europe. This technique might have been imported in Sicily during the Hellenistic period from the Near East, where it is clearly attested