you know sometimes I understand ancient civilization because I too am pretty sure if we just cracked open a little hole in my skull with a chisel my brain must just get some room to breathe
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LOOKING FOR A SPOTTER
Hello I dabble in medieval medicine and I would like a spotter for the ever elusive act of self trepanation.
Skills must include:
-A strong stomach.
-A scientists will.
-Ample Knowledge of human anatomy, specifically focused on the skull.
-Ability to drive to a hospital
Position will be unpaid
Answer
If there’s one thing I have learned from tumblr it’s that the hole was inside you all along, just waiting for the right person to come along and appreciate it in a very normal way.
Answer
This is, perhaps surprisingly, possible. The modern version of the procedure (called drilling burr holes) even has a pretty usable survival rate.
Note that this will require a character who has significant medical training (as they will need to know some neuro-related physical diagnosis and at least have heard of burr holes and where to place them). It will also require a drill of some kind (like, technically it would be possible to scrape holes in the skull, but it would not be fun), some form of large syringe, a sharp blade, antiseptic, a light source, a way to shave hair, and sterile water or saline (boiled for 10 minutes should work). Of these, the syringe is probably the most difficult to find in a prison camp, but it plays a pretty key role in two parts of the procedure, so doing without it would be difficult.
The Exam:
Before your characters can start drilling, they need to know that they need to drill. I assume your patient character had some form of head injury leading to the brain bleed (something like a hemorrhagic stroke would be handled differently and will not be covered in this post) just knowing that a head injury occurred is a good start.
A medical character would do an assessment that involved determining the patient’s level of consciousness and other symptoms, and physically assessing the skull and other parts of the body. Someone with a low level of consciousness, signs of a skull fracture, and a pupil that was larger than the other and didn’t respond well to light likely has either swelling in their brain or a hematoma (brain bleed).
Today, we use the Glasgow Coma Scale (GCS) to determine level of consciousness in a standardized way. The GCS assigns numbers to how well a person responds to various tests, which makes it easy to determine the severity of a neurological injury as well as track response to treatment.
The GCS was invented in 1974, and, prior to its invention, there were many scales used. Most of them, unfortunately, relied on descriptors like “obtundation”, “obnubilation”, and “stupor”. While these words do have definitions, many of them were not standardized or specific enough to do what we can do today with the GCS.
Signs of a skull fracture include a palpable sunken spot in the skull, but they can also include severe point tenderness of the skull or severe hematoma over the skull. Other signs of (specifically a basilar) skull fracture include bruising around the eyes, behind the ears, blood in the space behind the tympanic membrane, and cereprospinal fluid dripping out of the nose or ears, however a basilar skull fracture is less treatable with burr holes than other types of skull fracture.
A simple eye exam can be done easily by looking at the eyes. In this case, one pupil (the dark spot in the center of the eye) being bigger than the other is an emergency. It means that the skull has so much pressure in it that the brain is being squished out of the small opening at the base of the skull, which presses on the nerve that makes the pupils change size. To determine whether the pupils respond to light, your character can either use a flashlight, or if one is not available, cover the eye and then quickly uncover it in bright sunlight and watch the pupil change size. Pupils should get larger in low light and smaller in bright light. This change should happen quickly, over less than a second, and should happen in both eyes at the same time.
Another sign that part of the brain is being squished out (called “herniation”) is decerebrate posturing. Normally, even if someone has reduced level of consciousness, they will withdraw from pain. In decerebrate posturing, when they are exposed to pain (such as by pressing and rubbing knuckles on the patient’s breastbone, or pushing the side of a pen into a nailbed), they straighten out their body, looking something like this:
For someone with decerebrate posturing, the pressure has to be relieved within about 2 hours or their chances of survival are very low.
Unfortunately, without a CT scan, there’s not really a way to know for certain that the increase in pressure is caused by bleeding rather than swelling. The burr hole procedure described below will help a bleed more than it will help swelling (it can largely resolve the bleed by draining the blood), however burr holes will drain some cerebrospinal fluid, which can help free up some space for swelling and can buy a little time.
Burr Holes:
Burr holes are essentially small holes drilled in the skull. They are used to both find and remove the blood. A lot of time it is a process of trial and error to find the bleed, so sometimes several holes will need drilled.
The most likely place for a hematoma to be is directly beneath the fracture. Because of this, the first hole drilled should be right next to the fracture site.
To drill the hole, your character should shave the spot, clean it with antiseptic (a bleach solution or a very high-proof alcohol would probably be the easiest to find in WWII) and cut a small flap of skin away from the skull where they want the hole to be. This will bleed a lot, but they can put some pressure around the area to help curb the bleeding. Then it is literally the case of drilling the hole down to the covering of the brain.
If the hole immediately begins to bleed dark blood once through the skull, the bleed was likely on top of the covering of the brain, which is the best case scenario. If it does not, the character will need to see into the hole. This will be difficult, but they can do it with a strong light source (including, if necessary, bright sunlight) and by dripping sterile water into the hole to remove blood.
If the covering of the brain is dark, almost black, the bleed is likely under the covering. They can carefully cut through the covering to let the blood out, however they will probably have to shave away some more of the skull first. Wherever the blood is, the next step is to inject water under a small amount of pressure into the space to loosen the blood and then suck it out of the hole with the syringe. Do this several times to make sure the most of the blood drains.
If your characters don’t find a pocket of blood near the fracture, they can start searching elsewhere. The next places to look are the following, starting on the same side as the larger pupil:
A final note is that, as antibiotics were probably not available in a prison camp in WWII, everything needs to be as sterile as possible. This means soaking the drill bit in antiseptic prior to use, packing the holes with gauze soaked in a dilute bleach solution, making sure everything that touches the wounds is as sterile as possible. It won’t be possible to do it perfectly, but the closer they can get, the better.
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I’m not into any of that woowoo bullshit but as a person with more migraine days than not, I really respect the first guy like 15k years ago who was like “no no, trust me bro, the spirits are saying you gotta drill a hole in my skull”
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“I feel like my head is going to explode.” Arthur massaged his temples with his knuckles and sighed. “There’s just too much… What are you doing?”
Scamandros paused in the act of removing a very large hand-drill from inside his coat and a shining ten-inch-long drill bit from an external pocket.
“If I bore a hole in your skull just here,” said Scamandros, tapping the side of his forehead, “it will relieve the pressure. I expect it is a side effect of your transformation into a higher Denizen-”
Everybody give it up for trepanation… trepanation will definitely solve your problems.
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2,300-year-old tool used for skull surgery unearthed at Celtic settlement in Poland
The tool was used for the traditional scraping technique of trepanation. Trepanation is a form of cranial surgery that was practiced in many ancient cultures
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For months now I’ve been on the hunt for any information regarding trepanation. I currently have plans to have the procedure done on myself for spiritual purposes, but I can’t find much information on it.
There was a very old website advocating for it, but it has been locked behind a password since 2003 and the old archives weren’t helpful. There was mention of a neurosurgeon in Mexico City willing to do the procedure but the email provided to ask for more information was understandably dead. I can’t find any information online about this surgeon and the woman who made the website passed earlier this year.
I also found a supposed church that advocates for it but the only evidence online was a few podcast episodes. The article I first heard about it was from over a decade ago but the podcast episodes are from a year or two ago, which is very strange. Looked like a complete dead end.
I don’t want to do the procedure without trained medical professionals involved for obvious reasons. I also won’t be operating on myself as I have a chronic pain condition that’d make it even more excruciating if I’m not heavily sedated. There’s a good chance I’d end up messing up somehow and possibly even give myself brain damage.
If anyone has any ideas or leads on where to find more information, please let me know. This is one of my more lofty and important goals that I’m determined to achieve one way or another.
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Bunnlops Fanart !!
I don’t usually do fanart (unless I’m drawing Spider-Man…) BUT. There’s a series I’m super into called “The Trepanation of Bunnyborn Lops” on Instagram by Bunnlops. It’s so fucking fire and I think you should check it out 🫶.
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ALTumm so which of your friends holds you down and which one drills a hole in your skull?
2024.10.11 sketchbook
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cranial escape hatch
Colored something that’s been sitting in my files for almost 2 years. Dazai has an escape hatch for his mental demons. Inspired by the trepanation chapter of a book on medical quackery.
