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During the investigation of Eneolithic - Bronze Age skeletons from the Northern Caucasus ten trepanned skulls from Stavropol region, Ingushetia and Kabardino-Balkaria were examined. The trepanations were investigated macroscopical, by plain radiography and computed tomography. The holes were described in all aspects regarding technique, localization, size, shape, state of healing and complications. The nine cases (of 118 adult and 19 juvenile individuals) could easily be divided into two groups: in four cases the holes were situated in different areas of the skull and seemed to be trauma-related. In five cases the trepanation holes were situated straight on the sagittal line, mostly in the part of the obelion without any signs of trauma. Another one (of 5 adult and 5 juvenile individuals), displaying a postmortem trepanations, is discussed considering special funeral tradition of ritual manipulation with a dead. Nine males and females received the operation between the age of 10 years and mature/senile age. As techniques grooving, scraping and linear cutting were used, their application differed between sexes. The majority survived the intervention for a long time. The postmortem trepanation was done on human remains of mature female. The case display manipulation with a body after the short time of burial of the dead. The region seems to be a center for special trepanations performed by skilled surgeons, the specific localization of the holes in the head of five cases implying more a ritual than therapeutic reason for trepanning. There is no direct analogy of postmortem trepanation, which is described first time for the region. Investigation was partly sponsored by Russian humanitarian scientific fund; Grant number: 16-21-19000.