OBJECTIVE:Trephination of the cranial vault is the oldest known surgical procedure and has often been reported in the literature. The present study was performed to study the incidence, the techniques used, and possible indications for trephinations in the region of Mecklenburg-Vorpommern, the most northeastern German state.METHODS:One hundred thirteen of a total of 115 Neolithic (c. 2000–3500 BC) skulls and eight smaller skull fragments found in the region of Mecklenburg-Vorpommern were examined. Defects and abrasions were detected in 31 of these skulls and underwent further examination (careful microscopic and/or endoscopic examination, three-dimensional computed tomography, and x-rays).RESULTS:Six skulls showed defects resulting from trephination, mainly located along the midline or in the left parieto-occipital region. There was good osteological evidence that at least five of these operations had been survived. Two different techniques for trephination (circular cuts and scraping) had been used.CONCLUSION:From the present study, we conclude that the incidence of trephination in Neolithic skulls in our region is at least 5% and that these operations had been survived in singular cases. There is increasing evidence that these procedures were intended to be curative.