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Injuries have always been a part of human lives and the attempts to relieve the effects of skull injuries should have developed the medical skills of primitive healers. One of the forms of assistance was surgical intervention - trepanation. In Eurasia, Paleolithic hunter-gatherers were the first to perform trepanations. One of the oldest examples dated to the upper Paleolithic is found in Kostenki 8 site, Russia. Mesolithic hunter-gatherers performed more trepanations. One of the oldest known operations is a case from Ukraine (Vasilyevka III). Trepanation was performed by drilling the skull vault long before the individual's death. One of its alleged causes could be an injury that led to a headache, thus the operation was made to relieve it. Later in in this area, at the early stages of agriculture, this tradition was preserved: Vasilyevka II burial ground is dated to a slightly later time, but the trepanation was performed in the same way as the previous case by drilling. The Eneolithic period of the Eastern European steppes in 5000-4000 BC was a time of the formation of pastoralism, wide migrations, cultural contacts and social transformations. It was a transition between the hunter-gatherer lifestyle and producing economy. The change in lifestyle could be reflected in the change of spiritual traditions, which may have been reflected in surgical practice. Eight cases of trepanations dated to Eneolithic period of the south of Eastern European steppes were studied. The holes were described in detail regarding technique, localization, size, shape, state of healing and complications. The majority of the trepanned long survived the intervention. The region seems to be a center for special trepanations performed by skilled surgeons. According to the localization of the trepanations we suggest both ritual and therapeutic purposes for the operations. Our acknowledgment to RFBR (Grant #: 17-29-04125) and ARCHCAUCASUS Keywords trepanations, Eneolithic period, North Caucasus, rituals, the medicine, traumas