Skullsplitter Fetish

Skullsplitter Fetish is a quest item only lootable by players on the quest Troll Witchery. Brother Nimetz believes these instruments of troll magic may hold the secret behind Colonel Kurzen's corruption.

Source
This item drop from Skullsplitter Witch Doctors and Skullsplitter Mystics. These trolls can be found in the three central troll ruin sites of Stranglethorn Vale (Ziata'jai Ruins, Ruins of Zul'Mamwe, and Balia'mah Ruins).

As a quest objective

 * Troll Witchery - From at the Rebel Camp in Stranglethorn Vale, after completing Kurzen's Mystery
 * Required:
 * Skullsplitter Fetish x4