Giffords Undergoes Skull Operation
ROBERT SIEGEL, host:
Congresswoman Gabrielle Giffords underwent surgery today. Doctors in Houston say they replaced part of her skull with a plastic implant, and that she's recovering well.
MICHELE NORRIS, host:
The Democrat from Arizona has been living without a piece of her skull, at times wearing a helmet, since she was shot in the head in January.
And we're joined now by Dr. Peter Nakaji. He's director of the Neurosurgery Residency Program at the Barrow Neurological Institute; that's in Phoenix, Arizona. He's not involved in the congresswoman's care, but he's here to talk with us about what the surgery involves.
Dr. Nakaji, welcome to the program.
Dr. PETER NAKAJI (Barrow Neurological Institute): Thank you, Michele.
NORRIS: Could you quickly outline today's procedure for us?
Dr. NAKAJI: Well, what would usually happen is that they'll reopen the incision that they made in the first place and expose the skull and find the edges. And then they'll take that implant, which should be perfectly custom-made for her, and just drop it right in almost like a puzzle piece.
NORRIS: Should we assume that there is a certain amount of risk associated with a surgery like this?
Dr. NAKAJI: Yeah. Every surgery has risks. And the major ones for the surgery are infection of the implant because it's a foreign object, or bleeding. But overall, this is a relatively safe surgery, much less complicated than the surgery she went through before to take out the bone flap.
NORRIS: Mm-hmm. And we noted that she - that Congresswoman Giffords is receiving a plastic implant, meaning that the original piece of her skull was too damaged to put back in?
Dr. NAKAJI: Yeah. Usually, in a gunshot wound case, the bone is so fractured that it's difficult to put it back in in a meaningful way, or that it's been contaminated by the bullet, and it's just not safe to put it back in for fear of infection. So this would be a very common thing to do.
NORRIS: Does this mean that that plastic implant will be permanent? Is that something that Congresswoman Giffords will live with for the rest of her life?
Dr. NAKAJI: Yes. There will be a plastic implant in there. It may be incorporated into her own bone. But ultimately, it will be there forever.
NORRIS: What do you - it's an odd question, but if it's there forever, then we assume that the piece of skull that was removed, that will not be replaced. That will not be put back.
Dr. NAKAJI: Right. That bone, typically, once we're sure that the other one has taken, it will be taken out of the freezer and, with the family's permission, it will be discarded.
NORRIS: Mm-hmm. She's been able to move about. She's been quite mobile wearing that helmet. Why would she keep that head piece on? I imagine that's to protect a part of her head, her brain that was exposed.
Dr. NAKAJI: Right. As tough as your scalp is, it's still not as strong as your skull, which otherwise would be underneath protecting your brain. So you do have to have some kind of external protection against a blow to the head. So that's the purpose of that. But as soon as the bone flap is replaced, she can come out of that helmet.
NORRIS: Now, I understand that you've done a procedure much like this just this week.
Dr. NAKAJI: Yeah. We had a case to replace one on Monday and a case, actually, for a very similar case also this week. So it is something that we do here relatively commonly.
NORRIS: Hopeful development?
Dr. NAKAJI: Yeah. I think it's all good. It's all good. And I think it's a good milestone for the congresswoman.
NORRIS: It's, you know, as we noted, and many people will remember, the shooting took place back in January. We're some months forward now. Do you have to wait this long to make sure that all the swelling has gone down?
Dr. NAKAJI: Right. You can't sort of push the brain back into the head. You have to wait for it to swell up and then it will gradually sink back into the head. And once it's done that and the normal contour is there, that's the best time.
NORRIS: Tell me about the recovery process from something like this.
Dr. NAKAJI: You know, there's two parts of the recovery process. I think the first is that the scalp just has to be opened and closed again. And that's relatively straightforward healing, much like plastic surgery would be. The other part of it is the incorporation of the bone, and that takes a lot longer. But the last part, really, is the psychological part. This is usually when people start to feel like they're really on the road to recovery because they look in the mirror and they see themselves again instead of someone they didn't expect to see.
NORRIS: Hmm. And is this where a certain sort of mental toughness kicks in, because we keep hearing again just how hardy Congresswoman Giffords has been?
Dr. NAKAJI: Yeah. Definitely, it helps at every stage of recovery. But in some ways, this is the hard part. The drama part is gone a little bit, and now it's the facing the long, hard slog to recover. But this is the part that I always tell the families, this is where you really need to buckle down because this is where the hard work begins, but really, where the great gains are made too.
NORRIS: That's Dr. Peter Nakaji. He's a neurosurgeon at Barrow Neurological Institute in Phoenix, Arizona.
Doctor, thank you very much.
Dr. NAKAJI: Thank you, Michele.
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