Results of a science-based analysis of ante-mortem trepanation carried out by Scythian Age surgeons of Gorny Altai (4th–3rd centuries BC) are presented. Inductively coupled plasma-mass spectrometry, energy dispersive X-ray fluorescent analysis using synchrotron radiation, and magnetic resonance tomography were supplemented by micro- wear experiments. All trepanations were performed by scraping and included two stages. The bone tissue around the holes reveals high concentrations of copper and tin but no traces of iron or arsenic, suggesting that surgical instruments were made of tin bronze. A knife, experimentally manufactured of copper, tin, and zinc alloy and shaped like knives used by Southern Siberian nomads, was successfully used to perform trepanation on a cadaver.