Berengario's drill: origin and inspiration

Abstract

<jats:p>Craniotomies are among the oldest neurosurgical procedures, as evidenced by early human skulls discovered with holes in the calvaria. Though devices change, the principles to safely transgress the skull are identical. Modern neurosurgeons regularly use electric power drills in the operating theater; however, nonelectric trephining instruments remain trusted by professionals in certain emergent settings in the rare instance that an electric drill is unavailable. Until the late Middle Ages, innovation in craniotomy instrumentation remained stunted without much documented redesign. Jacopo Berengario da Carpi's (c. 1457–1530 CE) text <jats:italic>Tractatus de Fractura Calvae sive Cranei</jats:italic> depicts a drill previously unseen in a medical volume. Written in 1518 CE, the book was motivated by defeat over the course of Lorenzo II de'Medici's medical care. Berengario's interchangeable bit with a compound brace (“vertibulum”), known today as the Hudson brace, symbolizes a pivotal device in neurosurgery and medical tool design. This drill permitted surgeons to stock multiple bits, perform the craniotomy faster, and decrease equipment costs during a period of increased incidence of cranial fractures, and thus the need for craniotomies, which was attributable to the introduction of gunpowder. The inspiration stemmed from a school of thought growing within a population of physicians trained as mathematicians, engineers, and astrologers prior to entering the medical profession. Berengario may have been the first to record the use of such a unique drill, but whether he invented this instrument or merely adapted its use for the craniotomy remains clouded.</jats:p>

Trepanation revisited in COVID-19 era: A perspective on craniotomy during current pandemic, surgical technique, and complications avoidance

“…The “vertibulum” used by Berengario was a prelude to modern craniotomy instruments. [ 3 ] Trepanation is the most ancient form of surgical practice since the prehistoric age. [ 7 , 9 ] The oldest trepanned specimens have been found in Africa and Europe dating 10,000 BC.…”

Trepanation of the Cranium from the middle Sarmatian times on the Volgograd region territory

“…Ñâåðëåíèå -îäèí èç íàèáîëåå ðàñïðîñòðàíåííûõ ñïîñîáîâ ïðîâåäåíèÿ òðåïàíàöèè ó ðàç-ëè÷íûõ íàðîäîâ çåìíîãî øàðà [Ãîõìàí, 1989;Áóaeèëîâà, Äîáðîâîëüñêàÿ, Ìåäíèêîâà, 2006;Áåéñåíîâ, Êèòîâ, 2014;Drennan, 1937;Wilkinson, 1975;Rawlings, Rossitch, 1994;Brothwell, 1994;Campillo, Safont et al, 1999;Crubezy et al, 2001;Sankhyan, Weber, 2001;Nystrom, 2006;Acikkol et al, 2009;Likovsky, Malykova, et al, 2010;Erdal, Erdal, 2011;Pitsios, Zafiri, 2012;Kurin, 2013;Chorney, Gandhi et al, 2014;Tiago, Silva et al, 2015.…”

Treatise of Jacopo Berengario da Carpi “De fractura calve”

“…После проникновения более чем на половину толщины кости можно использовать другой инструмент без заостренного конца, чтобы избежать прокола твердой мозговой оболочки. Таким образом, Беренгарио различал «мужскую» версию с режущим штифтом на конце и «женскую» -без него [2,12].…”