Evidence of cranial surgery in human history exists as early as the Mesolithic period before spreading even further during the Neolithic1,2,3. It is well represented throughout the world, and its use has been documented in skeletal remains from every continent; most of them from the Mesolithic to the present time2,3,4,5,6,7,8,9,10,11,12,13,14,15,16,17 (http://www.holeintheheadmovie.com). The most ancient example of a trepanation is described by Samuel George Morton18, in his famous book Crania Americana published in 1839: a skull from South America displayed a hole that Morton did not recognize as a trepanation, but as a wound attributed to a blunt instrument. The purpose of such a practice to treat functional disorders or as part of a magical-religious ritual has long been discussed without arriving at a conclusive answer14. The purpose of such a practice, we suppose, most probably depends on the societies and/or the period in question. Independently of the reasons that led humans to carry out trepanations, one cannot but be amazed by prehistoric man’s knowledge and mastery of the techniques of cranial surgery. Indeed, the oldest crania with evidence of trepanation reveal the use of the same techniques as those used in historic times with the same degree of accuracy19. Similar techniques are recorded all over the world. The bone was scraped or cut or drilled preventing any break of the inner table of the skull bone so as not to compromise the health and integrity of the brain.

How people involved in this cranial surgery acquired the training to practice the operation on humans is unknown. It is possible that they practiced on the skulls of the dead, but in that case the gestures could not have been fully assessed. That is to say, gestures developed on the crania of cadavers could lead to brain damage when practiced on living patients and it would be difficult to recognize dangerous gestures on anyone but live patients. It is also possible that they trained on live animals. A wild boar cranium (Sus scrofa) probably from a Neolithic site in Roquefort, France shows signs of a surgical operation20. Unfortunately, complete skulls of animals are rarely found in archeological sites since they were eaten and the skulls were most probably broken to extract the tongue and the brain.

The Neolithic site of Champ-Durand, Vendée, France, situated at around 40 km from the Atlantic coast, on the northern border of the Poitevin marshes, was a fortified locality with three series of ditches and described as an important trade center for local populations specialized in salt production and trade as well as in cattle slaughter in 5000 BP21,22 (Supplementary Information). Archeological excavations of the ditches carried out from 1975 to 1985 enabled researchers to find important quantities of faunal remains. Cut-marks on bones and burned bones indicate that domestic animals such as cows, pigs, sheep and goats were the principal source of meat23. Similarly to other neighboring Neolithic sites, the cow (Bos taurus) is the species most represented and corresponds to 54% of animal remains. An almost complete cow cranium, lacking only the anterior part of the maxilla and the extremities of the horns, shows a hole in the right frontal bone. In a previous work, the hole was interpreted as resulting from goring by another cow23, however a quick visual inspection of the bone surface shows some features that seem to indicate that the hole may be related to human activity. The aim of this work is to assess if the hole in the cow cranium is the result of human intervention.