Giffords' brain trauma shines light on new treatment

"The decision to do surgery in the first place, I would look at as a good prognosis indicator," says Curry. "If someone comes in to the hospital fully comatose, intervention is probably futile after a high velocity gunshot wound."

In Giffords' case, the surgery was performed largely to irrigate the area where the bullet penetrated and remove debris like skull fragments in order to prevent an infection. While the bullet passed completely through Gifford's brain, most of the time surgeons don't attempt to remove bullets that become lodged in the brain since the removal can do more damage than leaving it in.

The other part of Giffords' surgery -- becoming far more common these days -- was a prophylactic procedure to remove a piece of her skull to allow the brain to swell without brushing up against the skull, which can reduce blood supply to brain tissue, doing further damage.

This procedure, called decompressive craniectomy, has come into common practice for gunshot wounds to the head because several recent studies have shown that it improves clinical outcomes like cognitive function, recovery time, and overall survival, says Curry.

"The question remains," Curry adds, "when should you do the craniectomy -- immediately upon arrival at the hospital or as a salvage technique after brain swelling has begun." The trend these days is to perform the procedure prophylactically since the benefits appear to outweigh the risks.

Still, the risks can't be dismissed: A 2010 Australian study published in the Journal of Neurotrauma found that more than 55 percent of head trauma patients who had the procedure suffered at least one related complication like seizures, infections or deterioration of the skull bone after it had been replaced.

Plus, the procedure is usually paired with long-term anesthesia to reduce the brain's metabolic rate, which lowers blood flow and the risk of swelling. It also keeps the patient from getting agitated, says Curry, which could increase swelling further. The drawback to this medically induced coma, he adds, is often short-term memory loss.

How much memory loss is caused by the anesthesia and how much by the injury itself often remains unknown. But the need for cognitive rehabilitation is almost a given with any patient who suffers a brain trauma on par with Giffords'.

Many patients who have had trauma on the left side of their brain, like Giffords, often have problems remembering words because the vast majority of us are left-brain dominant, says Curry. Personality changes, memory loss, and paralysis on the right side, controlled by the left-side of the brain, can also occur.

"But there are always patients who astound you with the speed of their recovery," says Curry. "The brain is an amazingly plastic organ; once it gets past that initial injury, it has the ability to bounce back."