WEDNESDAY, May 18 (HealthDay News) -- Rep. Gabrielle Giffords,
shot in the head four months ago by a would-be assassin, will
undergo surgery Wednesday in Houston to replace the piece of skull
that was removed immediately after the shooting, according to the
This next step in a recovery described as miraculous comes only
days after the three-term Democratic congresswoman from Arizona
traveled to Florida to see her husband, Mark Kelly, rocket into
space on the space shuttle Endeavour's last mission.
While this is a major move forward, it will have no effect on
her neurological status, and any speech or other therapy will
continue, according to one expert, Dr. Anders Cohen, chief of
neurosurgery at The Brooklyn Hospital Center in New York City.
"This is part of the recovery," Cohen said. "This is on the happier side, because it is not lifesaving. Swelling is no longer an issue, so let's protect the brain and let's give her a better cosmetic look. It's a quick thing with a fast recovery," he said.
After the shooting in Tucson, which killed six people and
wounded 12 others, doctors removed a large piece of Giffords' skull
to give the brain room to swell. It's likely that the bullet that
pierced her brain also shattered the bone, experts said.
Cohen, who is not involved in Giffords' care but is familiar
with news reports about her progress, said surgeons usually remove
a piece of skull about the size of a hand. Had the skull remained
intact, significant brain damage and even death might have
occurred, he said.
"When the brain swells, the skull, which usually protects the brain, becomes your worst enemy," he explained.
Replacement surgery isn't done until the swelling stops and the
brain has shrunk back to its normal size, Cohen added.
The replacement piece will probably be a custom-made plastic
implant that fits the opening perfectly, said Dr. Ricky Madhok, a
neurosurgeon at North Shore University Hospital in Manhasset, N.Y.,
and Nassau University Medical Center in East Meadow, N.Y. It is
meant to protect the brain and give her head a natural appearance,
"To replace the part of the skull, certain types of plastic can be used to recreate the skull," explained Madhok, who is not involved in Giffords' surgery. "Keep in mind, the purpose of the skull is to provide a protective barrier to the brain, whether that is done by bone or by a specially designed plastic."
The technology for these replacement implants is now very
advanced, he added. "One of the biggest things to be developed in
this area is custom designed implants," Madhok said. "As such,
using finely cut CT scans, each implant can be made to fit and
recreate the skull in such a way that the overall fit is as if the
original bone itself was replaced."
"Within a week, you get a ready-made prosthetic that exactly matches the defect," Cohen added.
Surgeons will attach the plate to the skull with titanium
brackets, then draw the scalp over the plate, Cohen said. The
implant will be concealed and hair will grow over it.
"As soon as you close the scalp, the patient looks symmetrical again. The cosmetic result is very striking right from the get-go," he said. "They look like themselves again right away."
Cohen said the risks of the surgery are minimal compared to what
Giffords has already been through. "You are not really doing any
brain surgery at this point," he said. "It's a fast procedure,
usually taking under an hour," he added.
Madhok agreed. "Restoring the part of the skull that was removed
is routine if patients have a good outcome to replace the defect.
While this procedure is still considered brain surgery, there are
much less risks than with the initial operation," he said.
Recovery from the procedure takes one or two days, the
Until this surgery is done, Giffords must be careful not to fall
or bump her head, which could harm the unprotected area of the
brain, Cohen said. Since her initial treatment, the congresswoman
has worn a helmet with an Arizona state flag decal on it, the
For more on head injuries, visit the
U.S. National Library of Medicine.
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