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For a large part of human prehistory, people around the world practised trepanation: a crude surgical procedure that involves forming a hole in the skull of a living person by either drilling, cutting or scraping away layers of bone with a sharp implement.

To date, thousands of skulls bearing signs of trepanation have been unearthed at archaeological sites across the world.

But despite its apparent importance, scientists are still not completely agreed on why our ancestors performed trepanation.

Anthropological accounts of 20th-Century trepanations in Africa and Polynesia suggest that, in these cases at least, trepanation was performed to treat pain – for instance, the pain caused by skull trauma or neurological disease.

Trepanation may also have had a similar purpose in prehistory. Many trepanned skulls show signs of cranial injuries or neurological diseases, often in the same region of the skull where the trepanation hole was made.

But as well as being used to treat medical conditions, researchers have long suspected that ancient humans performed trepanation for a quite different reason: ritual.

The earliest clear evidence of trepanation dates to approximately 7,000 years ago. It was practised in places as diverse as Ancient Greece, North and South America, Africa, Polynesia and the Far East. People probably developed the practice independently in several locations.

Archaeologists have turned up some of the best evidence for ritual trepanation ever discovered

Trepanation had been abandoned by most cultures by the end of the Middle Ages, but the practice was still being carried out in a few isolated parts of Africa and Polynesia until the early 1900s.

Since the very first scientific studies on trepanation were published in the 19th Century, scholars have continued to argue that ancient humans sometimes performed trepanation to allow the passage of spirits into or out of the body, or as part of an initiation rite.

However, convincing evidenc

e is hard to come by. It is almost impossible to completely rule out the possibility that a trepanation was carried out for medical reasons, because some brain conditions leave no trace on the skull.

However, in a small corner of Russia archaeologists have turned up some of the best evidence for ritual trepanation ever discovered.

The story begins in 1997. Archaeologists were excavating a prehistoric burial site close to the city of Rostov-on-Don in the far south of Russia, near the northern reaches of the Black Sea.

The site contained the skeletal remains of 35 humans, distributed among 20 separate graves. Based on the style of the burials, the archaeologists knew that they dated to between approximately 5,000 and 3,000 BC, a period known as the Chalcolithic or “Copper Age”.

Less than 1 percent of all recorded trepanations are located above the obelion point

One of the graves contained the skeletons of five adults – two women and three men – together with an infant aged between one and two years, and a girl in her mid-teens.

Finding multiple skeletons in the same prehistoric grave is not particularly unusual. But what had been done to their skulls was: the two women, two of the men and the teenage girl had all been trepanned.

Each of their skulls contained a single hole, several centimetres wide and roughly ellipsoidal in shape, with signs of scraping around the edges. The skull of the third man contained a depression which also showed evidence of having been carved, but not an actual hole. Only the infant’s skull was unblemished.

The job of analysing the contents of the grave fell to Elena Batieva, an anthropologist now at the Southern Federal University in Rostov-on-Don, Russia. She immediately recognised the holes as trepanations, and she soon realised that these trepanations were unusual.

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