This is a concise study of the prehistorical trepanation which we have interpreted on the basis of our personal experience from the examination of more than three thousand skulls. We have also inquired into the reasons that have given rise to trepanation, and at the same time have tried to clarify some of the inconsistencies of this subject. The study includes reference to the pathological lesions that are more frequent in the prehistorical skulls. In iconography there are few samples of these lesions in which the diagnosis is very difficult.
RESUMENLa mano, òrgano esencial de la especie humana, seguramente ha sufrido afecciones patológicas iguales o semejantes a las actuales; sin embargo, los paleopatologos no las hemos constatado hasta períodos muy recientes, seguramente debido a los procesos tafonómicos. En el presente trabajo aportamos nuestra experiencia y revisamos someramente los casos publicados por otros autores que hemos podido consultar, incluyendo las prácticas punitivas y rituales a que los humanos se han visto sometidos. SUMMARYThe hand, essential organ of the human species, surely has suffered patological affections equal or smimilar to the present day ones, nevertheless, the paleopathologists have not verified them until very recent times, certainly due to the taphonomic processes. On the present study we furnish our experience and, check superficially, the cases published by other authors that we have been able to consult, including the punitive and ritual prectices that the human have been subjugated. INTRODUCCIÓNEl hombre como primate, tiene una serie de características comunes a su orden zoológico y otras particulares propias del género y especie a que pertenece. No comentaremos todas las características comunes a su orden limitándonos a aquéllas que guardan relación con las manos. En los primates se conservan una serie de caracteres arcaicos que se combinan con otros muy evolucionados: entre los primeros están la pentadactilia, ya presente en muchos reptiles del secundario, y la persistencia de las clavículas, y entre los segundos, el gran desarrollo del encéfalo, la visión binocular cromática y la oposición del primer dedo, por lo menos en las extremidades anteriores o superiores. En el caso concreto del hombre, es de destacar la amplia representación cortico-cerebral motora para la mano en la circunvolución frontal ascendente y otro tanto ocurre, en la parietal ascendente, con el área reservada a la sensibilidad táctil. En el hombre la oposición del pulgar alcanza su grado máximo, siendo el quinto dedo en menor grado también oponible. La sensibilidad cutánea de la mano, sobre todo a nivel del pulpejo de los dedos, alcanza un nivel muy alto, como lo de-
After a study of approximately 3,000 ancient skulls, from the Neolithic period to the Late Middle Ages, the presence of five lesions suspected of having corresponded to a meningioma during life were detected.The study is comparative with the current clinical picture of these lesions, with regard to their morphological as well as to their radiographic aspect. We consider that the situation of the lesions, the macroscopic appearance of the osteogenic or osteoloytic alterations, associated vascular grooves, age and sex is sufficient to diagnose these tumours with a small margin of error.
EXCEPT for meningiomas, which often infiltrate the dura mater and skull, 23,6s one of the most outstanding and wellestablished features of primary intraeranial tmnors is their tendency to remain concealed within the dural sac, inside the craniospinal bony cavity. 5,~2,81,73 This usually holds true even when a recurrence develops after operation or when a glioma spreads by way of the cerebrospinal fluid pathways, as occurs often with medulloblastomas, ~,s,9,~5,31 ependymomas, 24'52,5s,66 oligodendrogliomas, 47,4s and sometimes with sarcomatous involvement of the leptomeninges. 4,6Nevertheless, exceptions to this rule may occur and one of us 45 reported in 195~ a case of very vascularized primary sarcoma (angiosarcoma) of the cerebellum in a 4-year-old boy which was removed surgically. A course of deep roentgen-ray therapy totalling 9,000 r was given after the operation. A year and a half later, a growth had developed in the muscles of the neck. The tumor, 5X~X3 cm. in size, was removed and a full course of roentgen-ray treatment totalling 10,000 r was given immediately after the second operation. Microscopical sections demonstrated that it was a fibrosarcoma. Investigations carried out to detect neoplastic growth elsewhere in the body gave negative results and the patient, who now has been followed for over 8 years, still is in good health. Therefore, it seems that the cerebellar sarcoma was a primary one, and the growth outside the skull, a metastasis.Earlier than this, the same senior author saw a cerebral glioma in a young adult with a * Read at the meeting of the Society of British Neurological Surgeons, Edinburgh, June 1960.long-standing history. At operation some tumor was found underneath the galea, outside tlle skull. Unfortunately, this patient was operated upon shortly after the end of the Spanish Civil War, and the pathological specimens were lost. IIowever, microscopical description of the tissue found outside the bone, as well as that within the brain, supported the diagnosis of glioma.In reviewing the literature we have been able to collect 81 cases of primary intracranial tumors and 1 of the eauda equina that gave rise to metastasis outside the cerebrospinal cavity.As always happens when surveying the literature covering a long span of time , there are some cases in which the histopathological identification of the lesions is difficult to establish because of insufficient data, as in the case reported by Lindner 46 under the diagnosis of "dural endothelioma" with metastasis in the urinary bladder; 1 published by Davis 25 of "spongioblastoma" of the left temporal lobe with metastasis in the right arm, lymph glands of the axilla, wall of the chest and lung, and 1 of "glioblastoma" with pulmonary metastasis reported by Mittelbach. 54 Lindner's case, as pointed out by many authors, could have been one of urinary carcinoma with metastasis to the brain and the other ~, as stated by Willis, 72 puhnonary carcinomas with cerebral metastasis.In other instances there may have been merely a co-existence of two ...
The skull of a native Mexican from the colonial period is studied. The skull has a nasal trauma, dental pathology and two osteogenic lesions, one situated at the left wing of the sphenoid bone and the other in the infrainion occipital squamous bone, between the left mastoid process and the left occipital condyle. That involving the sphenoid occludes the optic nerve foramen and is evident through the orbit and at pterion. These osteogenic lesions are considered to be secondary to the soft tissue tumour mass, which, at the level of its implantation area, is usually present in meningiomas.
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