Trepanation: What’s a little hole in the skull?

Trepanation: What’s a little hole in the skull?

Medicine has always been a little… experimental.
And some ideas refuse to stay buried.

Welcome to The Cadaver’s Lesson, a podcast exploring the strange, fascinating, and unsettling history of medicine. In this episode, we open the skull—carefully—to examine trepanation, one of humanity’s oldest surgical practices, and its surprising survival into modern medicine.

From ancient cultural rituals and early medical reasoning to battlefield trauma and emergency neurosurgery, we trace how drilling into the skull evolved into today’s burr holes and life-saving interventions. Along the way, we explore why trepanation made sense at the time, how patients astonishingly survived, and what it taught us about intracranial pressure, Cushing’s Triad, and critical neurological red flags.

Hosted by B, a true crime junkie drawn to psychology, ethics, and moral gray areas, and Sam, an ER Physician Assistant grounded in evidence-based medicine and clinical reality, this episode lives at the crossroads of history, trauma care, and modern emergency medicine.

The conversation also dives into the emotional toll of trauma care, the human stories behind brain injuries, and the ethical weight carried by medical professionals—past and present. By connecting historical practices to modern technology, we reflect on how medicine continuously evolves through questioning, adaptation, and hard-earned lessons.

New episodes drop Mondays, with companion historical case episodes on Fridays.

Follow along, stay curious, and remember—
Some lessons were never meant to survive.

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Class is dismissed.

📚 References

• Andrushko, V. A., & Verano, J. W. (2008). “Prehistoric Trepanation in the Cuzco Region of Peru.” American Journal of Physical Anthropology, 137(1), 4–13.
• Arnott, R., Finger, S., & Smith, C. U. M. (eds.). (2003). Trepanation: History, Discovery, Theory. Swets & Zeitlinger.
• Greenblatt, S. H., Dagi, T. F., & Epstein, M. H. (eds.). (1997). A History of Neurosurgery. AANS.
• Gross, C. G. (2004). “Trepanation from Antiquity to the Present.” Neurosurgical Review, 7, 1–5.
• Hippocrates. On Injuries of the Head.
• Martin, D., & Harrod, R. (2015). Bioarchaeology of Trauma. Wiley-Blackwell.
• Paré, A. (16th c.). The Works of Ambroise Paré.
• Prioreschi, P. (1991). A History of Medicine: Primitive and Ancient Medicine. Horatius Press.
• Roberts, C., & Manchester, K. (2005). The Archaeology of Disease. Cornell University Press.
• Verano, J. W. (2006). “Trepanation in Prehistoric South America.” World Neurosurgery, 66(3), 380–385.
• https://thereader.mitpress.mit.edu/hole-in-the-head-trepanation/ (On the historical methods of Trepanation)