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

During archaeological excavations conducted in 2010 at the Hellenistic necropolis of Messina (Sicily, Italy) dated to the 3rd century BC, a young adult male with multiple head injuries and evidence of surgical intervention was found. One lesion is located on the frontal bone and forms a full thickness perforation produced by penetrating force trauma. A second lesion is a healed superficial depressed fracture of the frontal bone caused by blunt force trauma. Both lesions show signs of healing indicating an extended period of survival. The third injury is a linear cut located on the inferior portion of right parietal; absence of signs of bone remodelling suggests a perimortem sharp force lesion inflicted by a bladed instrument. Finally, the left parietal bone reveals a rectangular area of bone loss involving a full thickness perforation of the bone with well-delimited incised edges and absence of healing. This lesion can be interpreted as a surgical intervention involving trepanation achieved by the linear cutting technique, the purpose of which was probably therapeutic and correlated with the multiple head injuries suffered by the individual. The linear cutting technique is most often found in the New World, while in the Old World only sporadic evidence of this technique has been attested, mainly coming from the Near East. Therefore, the case study from Messina represents the first evidence of neurosurgical intervention performed through the linear cutting technique found to date in Italy and the second case in the entirety of Europe.