Rep. Giffords Recovering After Skull Surgery

THURSDAY May 19, 2011 -- Rep. Gabrielle Giffords continued her remarkable recovery Thursday, one day after doctors inserted a plastic implant to replace the piece of skull that had been removed after she was shot in the head by a would-be assassin four months ago.

The Arizona congresswoman is "recovering well after her surgery today," read a Wednesday statement from TIRR Memorial Hermann Hospital in Houston, where the surgery was performed, the Associated Press reported.

Doctors removed the portion of skull to ease pressure on her brain, which swelled after she was shot.

Still, her doctors said Giffords continues to face a long road to recovery, and have repeatedly talked about reaching a new "normal," the AP said.

Wednesday's surgery, the latest step in a recovery described as miraculous, came only days after Giffords traveled to Florida to see her husband, Mark Kelly, rocket into space as commander of the space shuttle Endeavour's last mission.

While the latest surgery 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 would 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, he noted.

"To replace the part of the skull, certain types of plastic can be used to recreate the skull," explained Madhok, who was 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.

"As soon as you close the scalp, the patient looks symmetrical again. The cosmetic result is very striking right from the get-go," Cohen said. "They look like themselves again right away."

More information

For more on head injuries, visit the U.S. National Library of Medicine.

Posted: May 2011


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