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Among the graves brought to light by the Italian team in the large cemetery containing monumental shaft graves and simple pit and jar burials located in the northern part of the acropolis, under the Royal Palace, an atypical pit burial (Grave 21) was uncovered.

The grave consisted of a pit containing a skeleton in anatomical connection placed in supine position. The upper limbs were flexed and the legs absent (Fig.1). No grave goods were present. The skeleton belonged to a male, aged 25-35 years and 162.7 cm tall.

The cranial vault on the parietals and occipital bones showed a set of lesions caused by a metal blade (Fig.2). These injuries are compatible with trephination of the skull performed with a cutting technique. As documented by image magnifications, the scalp was probably reflected backwards (Fig.3), subsequently the repetitive cutting of the bone probably carried out with a coarse-toothed saw was performed (Fig.4).

 No evidence of healing was observed, thus suggesting death of the subject during or immediately after the operation or the use of a dead body to train in cranial trephination. Interestingly, X-ray in lateral projection shows marked “hair-on-end” appearance and porotic aspect of the cranial vault (Fig.5) indicating previous pathologic condition probably due to anemia or infection.

Nevertheless, the number of trephinations observed could also suggest uncertainty of the surgeon about the appropriate place to cut or training on a fresh cadaver as well.


Cranial trephination was the most ancient form of surgery of the history of medicine and this practice is worldwide diffuse and documented in several ancient cultures from the Neolithic. In the ancient Near East several cases of trephination observed in human skulls from Palestine were reported by literature, more occasionally in Anatolia, Iraq and Iran. At present the operation described here, together with a similar case from Ebla (Mogliazza pers. comm.), represent the first documentation in ancient Syria.


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