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Neurosurg Focus. 2014 Apr;36(4):E6. doi: 10.3171/2014.2.FOCUS13543.

How to get in and out of the skull: from tumi to "hammer and chisel" to the Gigli saw and the osteoplastic flap.

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  • 1Division of Pediatric Neurosurgery, Leo M. Davidoff Department of Neurological Surgery, Children's, Hospital at Montefiore, and Departments of Pediatrics and Plastic and Reconstructive Surgery, Albert, Einstein College of Medicine, Bronx, New York.


Making "holes in the skull" is an ancient art and by some is considered the second oldest profession in the world-the first being prostitution. Early surgeons, and later on neurosurgeons, devised a number of ingenious ways to make a hole in the skull or elevate a depressed skull fracture. Trephined skulls from antiquity have now been found in most parts of world, showing that the art of trephining is not only ancient but clearly widespread. Beginning with antiquity the author traces the development of this surgical skill by reviewing the various tools used and surgical designs to perform what is now called a craniotomy.

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