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Malala Yousufzai to Receive New Skull Made of Titanium

Veronique de Viguerie/Getty Images(BIRMINGHAM, England) -- Malala Yousufzai, the 15-year-old Pakistani schoolgirl who survived a Taliban attack and became a global icon of resistance, will soon have surgery to repair her shattered skull and damaged hearing.

In the next 10 days, Yousufzai will undergo a three-hour procedure to attach a titanium plate to a large hole in her head and to implant a cochlear hearing device to replace her destroyed eardrum.

The procedures, which will be carried out by the same surgeons who treat British soldiers injured in Afghanistan, will set the teenager on a road to recovery that will allow her to kick-start her work as a global advocate for girls' education and to begin a relatively normal life in Birmingham, England.

Yousufzai was shot point blank, three times last October.  One of the bullets hit her left brow and traveled under the skin along her head.  The bullet itself did not damage her skull, but its shock wave shattered her skull's thinnest bone and damaged the soft tissues at the base of her jaw and neck, according to the Queen Elizabeth Hospital in Birmingham, where she has been recuperating and where she will undergo her surgeries.

Doctors in Pakistan saved her life by removing a piece of her skull, reducing pressure on her brain as it swelled from the shock wave.  The large hole that doctors left -- approximately one-third of one side of her head -- will now be covered in a surgery known as a titanium cranioplasty.

Her doctors will shave her head and drape back the flap of skin covering the hole, exposing the dura, the fibrous membrane that covers her brain, the hospital said in a statement emailed to the media.  The 0.6 millimeter-thick plate will then be secured to her skull with screws placed into 2 millimeter-deep holes drilled into her head.  The flap of skin will then be draped back over the plate and stitched into place.

Her doctors in Pakistan stored the piece of skull in her abdomen, hoping it would survive and be reinserted into her skull.  It isn't clear why the surgeons in Birmingham decided to use a plate instead.

The titanium plate "emulate[s] the piece of bone that's been taken away," said Stefan Edmondson, the hospital's principal maxillofacial prosthetist in video provided by the hospital.  Edmondson created a 3-D computer model of Yousufzai's skull and shaped her titanium plate.

"We start off with a flat sheet of the titanium, and we start pressing it within the two-part mold," he explained, holding the plate in what looks like a stamping machine.  "And this is done over a period of one or two weeks, and we have to keep revisiting it, in a sense, to cut it down slightly, make modifications."

In the second procedure, the small cochlear device will be implanted to allow her to hear again in her left ear.  The bullet that damaged her skull also destroyed her eardrum and all the bones she needs to hear, the hospital said.

Yousufzai underwent emergency surgeries while still in Pakistan, and compared to those, her doctors in Birmingham have said these procedures will be less traumatic.  They will last only three hours, and she will be an outpatient within a week or two, they have predicted.  Nine people will perform the surgeries, including two neurosurgeons and a burns and plastics consultant surgeon.

Hospital officials have said Yousufzai shows no signs of long-term damage, is able to speak and read, and is expected to make a full recovery.

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