Surgical Instruments for Trepanation and Trephine in Modern Age

Abstract

In this chapter we review the instruments related to cranial opening and their historical evolution from the Middle Ages until the end of the nineteenth century. Instruments used for perforation of the skull have been modifications of the drillers similar to the old ‘terebra’ and the circular drillers with serrated edges that were similar to the old ‘modiolus’. The perforation tool was mounted in a handle and two basic models were used, those used with just one hand, borehole-like or T-handle, and those that had to be used with both hands or brace-like. A particular instrument was the ‘tripolides’, in which the drilling element was mounted on a tripod bracket that leaned on the patient’s head. Bone fragments were elevated with simple lifters, complex crane-like lifters or strong forceps. To enlarge the initial cranial opening surgeons made several drillings cutting the bone in between with a cranial saw. Other instruments for cranial opening were the chisel, mallet, ‘lenticular’, ‘tirefond’, ‘rugines’, ‘meningophylax’ and bone dust brush. Manufacturers used to gather the basic set of instruments for trepanation in cases.