The Surprising Beginning to Brain Surgery

It’s midday when Sandra walks unsteadily into the hospital and asks a nurse for directions to the Emergency Room. Her son drove her, she thinks. She can’t quite remember. She’s had a splitting headache for more than a day, and the pain is so bad, she wants to vomit. It’s even making her dizzy.

What happens next, happens very quickly.

In the ER, Sandra is examined by an emergency physician. Her head hurts and her confusion has grown. She has trouble answering questions. The doctor notices a bruise barely visible through her hair. Did she fall? Sandra can’t recall.

An emergency CT scan confirms the doctor’s suspicions—Sandra is suffering from a severe subdural hematoma, or a massive bleed inside her skull that is putting a dangerous amount of pressure on her brain. And it’s growing, threatening to herniate. This is when Sandra loses consciousness. With only seconds to save her life, the neurosurgeon shaves and sterilizes the area over the hematoma, grabs a small cordless drill, and aims it at her scalp.

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Sound intense? Well, it’s literally brain surgery. And the small hole that the neurosurgeon is carefully creating in the underlying bone will save Sandra’s life, immediately relieving the swelling and pressure on her brain, while allowing her physicians to drain fluids and address the cause. It’s called trepanation.

Surprisingly enough, trepanation—also known as “burr holes” and closely related to craniotomy and craniectomy—is actually the oldest known surgical procedure on record, with evidence of its use dating back as far as the Stone Age. (Which is another way of saying that the award-winning neurosurgery services available at Sarasota Memorial have been ~9,500 years in the making.)

And that little plastic drill? It’s the latest life-saving innovation in emergency neurosurgery, enabling our surgeons to react quicker than ever, at a time when seconds matter most.

The Ancient Origins of Neurosurgery – The Holy Incan Empire & Brain Surgery on the Buddha

Ever had a headache so bad, part of you wanted to crack your noggin open like an egg and let the pressure out? You’re not alone.

Long before anyone knew about nerves and neurons, physicians around the world instinctively grasped this same idea—and they all arrived at the same simple solution. And from France to Japan to Mesoamerica, anthropologists and paleontologists have uncovered skulls with the telltale signs of trepanation.

The oldest evidence of this early brain surgery comes from the Cappadocia region of Turkey, where scientists found the remains of a 25-year-old woman whose skull was carefully carved open at the base with crude obsidian tools more than 9,000 years ago. Bone regrowth indicates she lived for roughly 10 days after. And while evidence of trepanation in ancient Egypt remains scarce, scholars have discovered what they believe to be evidence of a 4,000-year-old attempt to surgically remove brain tumors from a patient in their 30s—a notable discovery not only in the history of brain surgery but also our understanding of cancer as an age-old affliction.

3,000 years later, this sort of primitive surgical oncology would become a common feature in dramatic tales of legendary physicians in the East, such as Jivaka, personal physician to the Buddha and known as the “Medicine King,” whose healing feats included removing two parasites from the Buddha’s brain, or Hua Tuo, who diagnosed the King of Wei with a brain tumor that he alone could remove. (Unfortunately, the king’s previous physician had just tried to poison him, so his reaction to the proposed procedure was to have Tuo imprisoned and executed.)

Some of the richest history of trepanation, however, is found in the Peruvian Andes, home of the Incan Empire, where physicians spent nearly 1,000 years refining the practice and developing their tools, swapping obsidian knives for hand-drills and curved metal blades, using alcohol and coca as anesthesia, perfecting the practice on cadavers like modern medical students. At its height, the survival rate doubled that of surgeons in the American Civil War. Some patients even survived multiple procedures.

The Spanish banned the practice in the 1500s.

The Modernization of Neurosurgery – Electrodes, Implants, & Emergency Medicine

Although scientific understanding of the brain and the nervous system grew by leaps and bounds through the Scientific Revolution, as physicians and anatomists discovered nerve cells and nerve stems, ganglia, dendrites, and all the rest, the art of brain surgery itself remained somewhat stagnant. It wasn’t until the 20th century—and largely the second half—that the field underwent the modernization that made it what it is today.

For example, throughout the 1800s, scientists slowly uncovered the bioelectric nature of the brain and the nervous system, but it wasn’t until 1950 that a Spanish doctor named José Manuel Rodríguez Delgado invented the first electrode that could be implanted into the brain to manipulate that bioelectricity for medical purposes. He famously demonstrated its power by standing in front of an angry bull and stopping it mid-charge with the implant, turning the creature suddenly docile. 22 years later, the first cochlear implant demonstrated the ability to continually stimulate a desired nerve with incredible precision, restoring the user’s hearing even under unpredictable (noisy) conditions.

With the birth of neuroprosthetics and implantable electrodes, neurologists and neurosurgeons found new avenues to treat conditions like Parkinson’s disease, epilepsy, and chronic pain. Proposed solutions for spinal cord damage and persistent paralysis show promise, while visual implants for the blind are progressing at unprecedented rates. And new discoveries are made every day.

At Sarasota Memorial in the year 2025, this means our patients have more options than ever before for neurological care. With a team of neurologists, neurosurgeons, neuroradiologists, endocrinologists, radiation oncologists, otolaryngologists, emergency medicine physicians, neuro-rehabilitation specialists and more, all backed by one of the largest health systems in the region, equipped with the only certified Comprehensive Stroke Center in the county, and honed at the cutting edge through the new Kolschowsky Research & Education Institute, our patients have access to the most advanced and effective treatments for

• Stroke and Cerebral Hemorrhage
• Brain and Spinal Cord Injuries
• Brain and Spinal Cord Tumors
• Epilepsy and Seizure Disorders
• Alzheimer’s Disease and Dementia
• Parkinson's Disease and Movement Disorders
• Multiple Sclerosis
• Neuromuscular Disorders
• Peripheral Nerve Disease
• Aneurysms and more

This includes:

• Deep Brain Stimulation
• Radio Surgery
• Skull-Base Surgery
• Surgical Thrombectomy
• Microvascular Spine Surgery
• Minimally Invasive Spine Surgery
• Radiofrequency Ablation
• Radiation Therapy
• GammaTile Therapy
• Intravascular Coiling
• and Craniotomy (trepanation)

But what about that drill? What about Sandra?

Even with great advances in our understanding of the human brain and how to treat it, and even with the amazing evolution of the tools at our disposal, some things never change and a good trepanation never goes out of style.

Sandra’s fine.

More About Neurological Services at SMH

Neurological Care at SMH

Comprehensive Stroke Center at SMH

Minimally Invasive Spine Surgery at SMH

Sarasota Memorial Neuromuscular Disorders Clinic

Sarasota Memorial Parkinson’s Disease Clinic

More Articles from the SMH Centennial Series

A Brief History of Anesthesiology

Celebrating Heroes In Medicine: Vivien Thomas

From Experiment to Essential: The History of Blood Donation

How A World at War Changed Medicine

The Medical Miracle of Modern Childbirth

A Hundred Years of Heart

Written by Sarasota Memorial copywriter Philip Lederer, MA, who crafts a variety of external communications for the healthcare system. SMH’s in-house wordsmith, Lederer earned his Master’s degree in Public Administration and Political Philosophy from Morehead State University, KY, and is excited for this new headache treatment.