The temporary resection of the cranial vault by Wilhelm Wagner (1848–1900) instead of trepanation: the cornerstone of the modern craniotomy

Abstract

In this paper, the authors trace the history of cranial temporary resection, described by Wilhelm Wagner (1848–1900) in 1889, which changed the paradigm of the cranial opening from trephining to the craniotomy. The objective of the temporary resection was to obtain wide openings in the skull, keeping the cranial flap attached to the soft tissues to maintain bone vitality. The cranial temporary resection was reproduced by the authors in an anatomical study faithfully following the original technique, demonstrating the feasibility of the surgical procedure as described by Wagner. Surgical steps include a large omega-shaped skin incision and a beveled cut of the bone with the chisel and mallet until reaching the dura mater, lifting the bone flap en bloc along with all superficial soft tissues. A literature review shows that the temporary cranial resection became a great success at that time because it allowed physicians to improve a number of constraints of the cranial opening using the crown trephine: bone vitality; a wide cranial window; easy, safe, and quick surgery; and economy of surgical instruments. The crude, primitive proposal of the temporary resection was ameliorated to quickly build the successful model of the modern craniotomy.