Earliest brain surgery in the Middle East uncovered at Megiddo

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When archaeologists excavated the remains of two brothers from more than 3,500 years ago in Megiddo, northern Israel, they weren’t expecting one of the brothers to have a square-shaped hole in his skull.

The precisely cut hole is the result of one of the earliest known brain surgeries performed in the Middle East, also known as a “trephination,” in which a piece of the skull is removed.

Trephination, sometimes called trepanation, is one of the oldest known surgeries, and civilizations around the world have been practicing the procedure for thousands of years. In France, one site dating back 6,500 years was found to hold 120 skeletons, 40 of which had undergone trephination.

Around a dozen ancient skulls with trephination holes have been discovered across the Middle East, said Rachel Kalisher, a PhD student at Brown University’s Joukowsky Institute for Archaeology and the Ancient World and the lead author of the study, which was published in the PLOS ONE journal this week.

Doctors today still use a variation on this surgery, called a craniotomy, to relieve swelling in the brain after a traumatic brain injury.

The two brothers from Megiddo were likely from a wealthy family and lived between 1550 BC and 1450 BC in the late Bronze I Age. They were buried underneath a house in one of the richest parts of the city. One of the brothers, who had an intact skull, died sometime during his late teens or early 20s. He died a few years before his brother, and was exhumed and reburied together with him when the second brother died.

The other brother, who had the trephination procedure, was between 21 and 46 years old when he died. There was no evidence of healing from around the trephination site, so he likely died immediately or soon after the operation occurred. The healing would have started a few weeks after the operation.

What has fascinated archaeologists involved in the study is that both of the brothers show evidence of being ill for an extended period of time. The bones recovered from both brothers were exceptionally porous and marked with lesions, leading archaeologists to hypothesize they suffered from a systemic illness such as leprosy, tuberculosis, or even a genetic disease.

Certain skeletal indications, including the presence of an extra molar and atypical face structure in the brother with the trephination, point to developmental disruptions that could point to a genetic disorder such as Cleidocranial dysplasia or Down’s syndrome. Both brothers showed evidence of being severely anemic, which can also stunt growth.

“These brothers were elite, they were part of the most wealthy class living at Megiddo, which was itself quite a wealthy city,” said Kalisher. “They weren’t part of the average population, and that’s what we believe allowed them to survive as long as they did with the illness that they had.”

“The location where they were found is very close to the palace of Megiddo,” explained Prof. Israel Finkelstein, the director of the School of Archaeology and Maritime Cultures at the University of Haifa and one of the co-authors of the paper. “You can see the elite manifestations from the architecture and other aspects.” The lower classes lived in the southeastern part of Megiddo, he said.

The brothers were buried on top of an elaborate stone tomb filled with gold, bronze, silver, and bone ornaments, which made headlines when it was discovered in 2016 due to its extravagant nature. Archaeologists discovered the remains of three people in the tomb bedecked with jewelry that predate the brothers by roughly 50 to 70 years.

Both the brothers and people buried in the tomb below them suffered from similar lesions on their bones, which could mean that they may have suffered from the same disease.

Researchers are still working to determine whether the brothers are genetically related to the people buried in the tomb below them, Kalisher said. Experts in Germany are researching whether the bone lesions are related to leprosy, which would make it one of the earliest cases of leprosy in the Middle East.