The oldest existing case histories of craniotomy are from the false Hippocratic writings, about 330 BC, and one is reconstructed about the death of Ptolemy VI in 145 BC. Greek surgeons had rational indications for trepanning, when the difficulties of the times are understood. All compound fractures were infected, so death from an extradural abscess was likely. Trepanning was intended to drain the extra dural space. Copyright 1999 Harcourt Publishers Ltd.