Long before modern neurosurgery emerged, the Inca civilization practiced some of the oldest known surgical techniques. The practice of trephination and craniotomy, performed using primitive methods such as abrasion, scraping, crosscut sawing, and drilling, dates back thousands of years. These procedures were some of the earliest forms of surgery, carried out by the sirkaks, the skilled Inca surgeons who laid the groundwork for the development of neurosurgery.

Archaeological findings have led to a deeper understanding of these practices through cultural osteology, a new field of anthropology that focuses on studying human remains. Human skulls are the most commonly studied artifacts, as they offer insight into the medical practices of ancient cultures. Remains found in tombs and mummies not only provide physical evidence of these practices but also showcase the surgical instruments, war tools, and medical substances used by the Incas.

Despite their rudimentary knowledge of disease and pathology, the Inca surgeons were remarkably skilled. Using stone and metal tools, they performed craniectomies with an impressive survival rate of 50-70% and a very low incidence of infection or complications. Their expertise was also supported by their knowledge of anatomy and natural medicine, which allowed them to use hemostatic agents, antiseptics, and even quinine for fever and malaria.

In the context of constant warfare, where soldiers often sustained head injuries, the Incas honed their surgical techniques not only for medical purposes but also for combat recovery. Their ability to perform these life-saving procedures on warriors with head trauma highlights their advancements in medical techniques that were far ahead of their time.

The Inca legacy in neurosurgery and medicine is a testament to their innovation and deep understanding of human health, marking them as pioneers in the history of neurosurgery.