30 Jan 2013

How doctors will repair Malala Yousafzai’s skull

Doctors explain the surgery that activist schoolgirl Mala Yousafzai will undergo to repair the hole in her skull left after she was shot in the head by the Taliban.

Malala, who was shot by the Taliban in October because she campaigned for better girls’ education, will under go three and a half hours of surgery to fix a plate over a large hole in her skull, and to repair her hearing in her left ear.

The 15-year-old was shot at point black range. The bullet hit her left brow and, rather than penetrating her skull, travelled under the surface of the skin – shattering the thinnest bone of the skull and destroying her eardrum and the bones for hearing.

Dr Dave Rosser, the medical director at Queen Elizabeth Hospital in Birmingham, outlined the procedure on Wednesday. Malala will undergo a titanium cranioplasty, in which a titanium plate covers the hole in her skull, followed by a cochlear implantation which will provide a sense of sound (see animation below).

The procedure

The titanium cranioplasty procedure is carried out first and will take between one and two hours. The head will be shaved at the wound location and the flap of skin covering it will be draped back. This will expose the dura – the tough fibrous membrane covering the brain.

A 0.6mm metal plate, that has been moulded from computer images of Malala’s skull (see video, below), will then be put in place. It is secured to the skull with screws placed in 2mm holes. The flap of skin is then draped back over the plate and stitched into place.

A cochlear surgeon then takes over from the neurosurgeon, fitting an electronic device to the inner workings of the ear to create a sense of sound. A small well will be drilled in the skull behind the titanium plate to allow the electronics to be implanted.

Malala was brought to the UK in October and left the Birmingham hospital in January. It was understood that Malala was to live in the UK after her father was given a job with the Pakistani consulate in Birmingham. The Taliban in Pakistan has threatened the lives of Mr Yousufzai and Malala since the shooting.