This volume is a major contribution to bioarchaeological studies worldwide, and particularly to the bioarchaeology and archaeology of the Central Andean region in South America. The author has compiled for the first time all known cases of ancient trepanation found in Peru, using piercing analysis for accurate diagnosis. Verano introduces the book with chapters devoted to defining the term itself and the history of this practice in the ancient world, describing cases from ancient Roman, Islamic, and Medieval European societies in order to provide a broader perspective on the problem. This discussion leads to the history of how Peru and its intriguing skulls with holes came into the agenda of modern scholars. Verano points out that the interest in ancient trepanation in Peru started with the publication of a human skull recovered in Cuzco by Ephraim G. Squier in the mid-nineteenth century. Despite the major efforts of scholars during the twentieth century, Verano is clear when he states that most previous studies of trepanation in ancient Peru have been limited to collections from a single geographic area or period, making it difficult to examine such issues as temporal and regional variation in techniques, survival rates, and possible motivations for the procedure (p. 7). As a Peruvian scholar, I find it heartwarming that Verano has quoted articles and books published in Peru that are often considered “obscure,” including newspaper columns dealing with trepanation in the ancient Andean region. This is very welcome; it shows Verano's fine scholarly work and his sensibility developed through working with Peruvian researchers over the years.

Verano analyzed hundreds of skulls to determine the type, technique, nature, and success (or failure) of the trepanations. This remarkable achievement was possible because he had access to new cases reported by current archaeological projects and multiple collections stored in museums in the United States and Peru. Based on these collections, Verano makes one of the most important statements in the book: the practice of trepanation in ancient Peru was highly circumscribed in time and space. It is clear now that trepanation started in the Paracas Bay (Ica) region during the Early Horizon (900–200 B.C.) and continued into the Early Intermediate Period (200 B.C.–A.D. 600). It reappeared in the central highlands, where it was very popular during the Late Intermediate period (A.D. 1000–1470); it was less popular but still present in the northern highlands during the same period. The art of trepanation was mastered by the Incas during the Late Horizon (A.D. 1470–1532) and practiced primarily in the southern highlands. Although it seems to have been lost or not recorded, it certainly continued throughout the colonial period and the first years of the nineteenth century. Verano makes this point based on descriptions such as Adolph Bandelier's account of an Aymara woman who was known to perform trepanations.

In my view, the most important contribution of Verano's book from a theoretical point of view is chapter 3. The concept of differential diagnosis of holes in the head is, in his own words, “a basic tool that paleopathologists use to distinguish the various causes of cranial defects. The process involves considering all possible causes, ruling out the most unlikely candidates, and reducing one's options until left with one or a few most likely diagnoses” (p. 21). This approach is carefully applied to all the cases presented in the book. These analyses are well supported and complemented by chapter 9, written by David Kushner and Anne R. Titelbaum, which explains ancient trepanation from the point of view of modern neurosurgery. Similarly, chapter 10, written by J. Michael Williams, explains in simple terms and based on modern medical cases why keeping the patient alive during recovery from traumatic brain injury was such a challenge in ancient times. Since Verano has demonstrated that the rate of survival for trepanation was over 40 percent, it is impressive that ancient Peruvians accomplished such success with their patients using limited technology.

The effort required on Verano's part to get access to and analyze skulls stored in various U.S. and Peruvian collections is noteworthy. Most of the human skulls collected by Muñiz, Hrdlička, or Tello were in fact found on the surface of looted cemeteries that would have been lost or destroyed if they had not been recovered by these scholars. The valuable information these skulls provide justifies collecting them and storing them in museums for many years. Had they not been collected, all the rich and informative evidence presented in this book would have been lost forever. Therefore, this is a good example of how such collections can be used in modern studies, one that illustrates the important role of museums, no matter where they are, in protecting and preserving these materials.

This book is not only another fine piece edited by Dumbarton Oaks Research Library and Collection but also an important field manual. I predict that it will be found on the tables of bioarchaeologists’ laboratories, rather than in the stacks of libraries. The detailed analyses of different skulls with trepanations, the wonderful illustrations, and close-ups of specific details make it an excellent reference book for scholars working on the art of trepanation and physical anthropology in general. Indeed, it makes me want to reopen all the boxes of human remains from my excavations and check them for traces of trepanation. Although it is unlikely that I would find such evidence due to the region in which I work, the spirit in which this book was conceived will lead scholars to pay more attention to skulls in their collections. This may result in reports of new cases. I congratulate the author and the publisher for the extensive texts and abundant illustrations presented in this book, which represent a significant contribution in an academic world where publication is often hampered by limits on word counts and images.