Transnasal excerebration surgery in ancient Egypt

Historical vignette

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Ancient Egyptians were pioneers in many fields, including medicine and surgery. Our modern knowledge of anatomy, pathology, and surgical techniques stems from discoveries and observations made by Egyptian physicians and embalmers. In the realm of neurosurgery, ancient Egyptians were the first to elucidate cerebral and cranial anatomy, the first to describe evidence for the role of the spinal cord in the transmission of information from the brain to the extremities, and the first to invent surgical techniques such as trepanning and stitching. In addition, the transnasal approach to skull base and intracranial structures was first devised by Egyptian embalmers to excerebrate the cranial vault during mummification. In this historical vignette, the authors examine paleoradiological and other evidence from ancient Egyptian skulls and mummies of all periods, from the Old Kingdom to Greco-Roman Egypt, to shed light on the development of transnasal surgery in this ancient civilization. The authors confirm earlier observations concerning the laterality of this technique, suggesting that ancient Egyptian excerebration techniques penetrated the skull base mostly on the left side. They also suggest that the original technique used to access the skull base in ancient Egypt was a transethmoidal one, which later evolved to follow a transsphenoidal route similar to the one used today to gain access to pituitary lesions.

Article Information

Address correspondence to: William T. Couldwell, M.D., Ph.D., Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, 175 North Medical Drive East, Salt Lake City, Utah 84132. email: neuropub@hsc.utah.edu.

Please include this information when citing this paper: published online January 6, 2012; DOI: 10.3171/2011.12.JNS11417.

© AANS, except where prohibited by US copyright law.

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Figures

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    Timeline illustrating the history of excerebration of mummies in ancient Egypt. Interm. = Intermediate.

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    A slightly transparent view from the top of the cranial vault showing anterior and middle cranial fossae. The defect in the cribriform plate is apparent, and, through it, the contents of the nasal cavity can be partially visualized. Reproduced with permission from Gupta R, Markowitz Y, Berman L, Chapman P: High-resolution imaging of an ancient Egyptian mummified head: new insights into the mummification process. AJNR Am J Neuroradiol 29:705–713, 2008.

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    Surface-rendered scans, inferior view looking up (left) and superior view looking down (right), showing the defect in the cribriform plate that establishes a communication between the nasal cavity and the intracranial space. Reproduced with permission from Gupta R, Markowitz Y, Berman L, Chapman P: High-resolution imaging of an ancient Egyptian mummified head: new insights into the mummification process. AJNR Am J Neuroradiol 29:705–713, 2008.

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    Coronal reformatted (left) and sagittal (right) CT scans of the skull obtained in a 21st dynasty mummy. Demonstrated is a defect in the roof of the ethmoid sinuses (arrows, left) of the anterior skull base that was created for excerebration via the transnasal route, shown with the arrow at right. Reproduced with permission from Hoffman H, Torres WE, Ernst RD: Paleoradiology: advanced CT in the evaluation of nine Egyptian mummies. Radiographics 22:377–385, 2002.

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