A case of therapeutic trepanation from 13th century Tuscany

During the archaeological excavations carried out in 2007 in the Medieval cemetery of the Church of S. Agostino in Poggibonsi, Tuscany (Italy), a collective tomb was investigated. The large funerary structure, which contained the skeletal remains of 24 individuals, is dated back to the 13th century. A skull, belonging to an adult male, was found among the skeletal remains showing evidences of two head lesions produced by bladed instruments. The first consists in a linear wound that involved only the outer cranial table of parietal bones; bone remodeling indicates that the individual survived the injury for a long time. The second is located on the right portion of the frontal squama and involves all the thickness of the bone with clean and well-defined margins; the absence of any traces of reparative processes and signs of healing allows a diagnosis of peri mortem lesion. Only the triangular extremities of this injury can be recognized because the central portion of the wound is obliterated by an oval bone loss, 3x2 cm, characterized by clean cutting-edges along the outer cranial table, whereas the margins of the inner cranial table are irregulars. In order to treat this lesion, the patient was submitted to a surgical intervention, probably performed to clean the wound and remove any bone splinters. Trepanation performed to treat cranial traumas was described in detail by several medical classic and medieval Authors, whose texts were available in the 13th century. In particular, the surgeon from Poggibonsi had access to the medical literature and he probably followed the prescriptions of the surgical texts, such as that of Albucasis, which was one of the most famous during the Middle Ages. Despite he was skilled in the management of head wounds, the surgical intervention failed and the patient dead in surgery or soon afterwards. This case represents a rare direct Middle Ages evidence of neurosurgery practised to treat a bone injury