Torkildsen’s Ventriculocisternostomy First Applications: The Anthropological Evidence of a Young Slavic Soldier Who Died in the Torre Tresca Concentration Camp (Bari, Italy) in 1946

SIMPLE SUMMARY: Forensic anthropology deals with human skeletal remains for law and humanitarian purposes, and it is crucial in determining identity, interpreting traumas, and estimating time since death. Although it adopts a wide array of methods from many disciplines, the macroscopic observation of skeleton morphological characteristics is sometimes exhaustive for differential diagnosis between malformations, degenerative diseases, post-traumatic or iatrogenic lesions. In some cases, as described in this study, skeletal remains show signs of specific surgical techniques, so characteristic as to reconstruct almost faithfully the pathological history of the individual to whom they belonged and the therapeutic procedures the subject underwent. It is of even more interest if considering that, based on the time of death, the subject was among the first individuals who underwent an innovative surgical technique that would have revolutionized the surgical approach to a disease until then incurable. In these rare cases, skeletal remains become the historical testimony of surgery evolution, showing the traces of how men have over time perfected the medical treatment of their fellows. ABSTRACT: Human skeletal remains are considered as real biological archives of each subject’s life. Generally, traumas, wounds, surgical interventions, and many human pathologies suffered in life leave identifiable marks on the skeleton, and their correct interpretation is possible only through a meticulous anthropological investigation of skeletal remains. The study here presented concerns the analysis of a young Slavic soldier’s skeleton who died, after his imprisonment, in the concentration camp of Torre Tresca (Bari, Italy), during the Second World War (1946). In particular, the skull exhibited signs of surgical activity on the posterior cranial fossa and the parieto-occipital bones. They could be attributed to surgical procedures performed at different times, showing various degrees of bone edge remodeling. Overall, it was possible to correlate the surgical outcomes highlighted on the skull to the Torkildsen’s ventriculocisternostomy (VCS), the first clinically successful shunt for cerebrospinal fluid (CSF) diversion in hydrocephalus, which gained widespread use in the 1940s. For this reason, the skeleton we examined represents a rare, precious, and historical testimony of an emerging and revolutionary neurosurgical technique, which differed from other operations for treating hydrocephalus before the Second World War and was internationally recognized as an efficient procedure before the introduction of extracranial shunts.