Neurosurg Focus / Volume 29 / December 2010 Neurosurg Focus 29 (6):E2, 2010 1 P ermanent alterations of the body (such as dental modiications, scariication, mutilation, tattooing, body piercing, and other types of body art and orna- ments) have been part of human culture from the begin- ning of history and have served as a way of differentiat- ing oneself and one’s tribe or clan from others. Lip pierc- ing was practiced among African and American tribes and was a sign of social status. Vikings employed dental modiication in order to look fearless and for aesthetic purposes. Induced deformation of the neonatal cranial vault is another example of these types of practices. Artiicial (also known as intentional) cranial deforma- tion results from manual manipulation of the skull and/or from the application of a deforming apparatus. It is mani- fested in morphological changes to the cranial vault. 1 Ar - tiicial deformation can take many forms; Gerszten and Gerszten 7 discuss as many as 14 unique cranial shapes resulting from different methods of deformation. The practice of artiicial cranial deformation has been docu- mented on nearly every continent and may have begun as many as 30,000 years ago. 19 The practice of deforming newborn heads was present in the whole of the American continent 4 from North America to Patagonia, but cranial molding in neonates was most widely practiced in Me- soamerica. The Maya was the main Mesoamerican civi- lization, noted for its development of written language, architecture, and mathematical systems. 2 The Mayans are among the most studied ethnic groups in the world. In many collections of Mayan skulls recovered by archaeologists, artiicial cranial deforma- tion is a common feature, and some collections show a di- versity of deformation styles. 3 When Columbus saw some of the natives in the New World, he wrote that they had “foreheads and heads much broader than any people.” 6 In this paper, we analyze the historical precedents, mechanisms, different types, and role of cranial vault mod- iication among the Mayans. Methods To gain perspective on this issue, we examined the historical and anthropological literature on intentional deformation practices in Mayan culture in the collections of the National Institute of Anthropology and History A look at Mayan artiicial cranial deformation practices: morphological and cultural aspects Samuel RomeRo-V aRgaS, m.D., 1 JoSé luiS Ruiz-SanDoVal, m.D., 2 aRtuRo SotomayoR-gonzález, m.D., 1 Rogelio ReVuelta-gutiéRRez, m.D., 1 miguel angel CeliS-lópez, m.D., 1 Juan luiS gómez-amaDoR, m.D., 1 uliSeS gaRCía-gonzález, m.D., 1 Raul lópez-SeRna, m.D., 1 ViCtoR gaRCía-naVaRRo, m.D., 1 Diego menDez-RoSito, m.D., 1 ViCtoR CoRRea-CoRRea, m.D., 1 anD SeRgio gómez-llata, m.D. 1 1 Department of Neurosurgery, Instituto Nacional de Neurologia y Neurocirugia “Manuel Velazco Suarez,” Mexico City; and 2 Department of Neurology and Neurosurgery, Hospital Civil de Guadalajara “Fray Antonio Alcalde,” Universidad de Guadalajara, Mexico Induced deformation of the cranial vault is one form of permanent alteration of the body that has been performed by human beings from the beginning of history as a way of differentiating from others. These procedures have been observed in different cultures, but were particularly widespread in Mesoamerica. The authors examined and reviewed the historical and anthropological literature of intentional deformation practices in Mayan culture. The Mayans per- formed different types of cranial deformations and used different techniques and instruments to deform children’s heads. The most remarkable morphological alteration is seen in the lattening of the frontal bone. Some archeological investigations link deformation types with speciic periods. This article provides a glance at the cultural environment of the Mayans and demonstrates the heterogeneity of this interesting cultural phenomenon, which has changed over time. (DOI: 10.3171/2010.9.FOCUS10200) Key WoRDS • Mayan culture • artiicial cranial deformation • archaeology 1