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Pakistani teen activist Malala will have titanium plate placed in her skull

By Ben Brumfield, CNN
updated 8:54 AM EST, Wed January 30, 2013
  • Malala chose the titanium over her own bone fragment
  • Doctors in Pakistan had removed the fragment to save her life, when her brain swelled
  • Hospital official: Malala has a great sense of humor
  • The Pakistani Taliban tried to kill her for standing up for girls' right to an education

(CNN) -- Malala Yousafzai was glad to hear that her long ordeal of surgeries will soon be over. Just two more to go, doctors in Britain say. Hopefully.

She will receive a titanium plate in the coming days, to cover an opening in her skull, and an inner ear implant.

Read more: Malala's journey from near death to recovery

A gunman shot the teenage activist in the head and neck in October as she rode home from school in Pakistan's Swat Valley.

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Islamist extremists from Tehrik-e-Taliban intended to kill her for taking a stand for the right of girls to get an education. The terrorists have said they will target her again.

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The 15-year-old's brain swelled dangerously days after the shooting, so doctors in Pakistan extracted a section of her skull about the size of a hand. Otherwise, the pressure in her cranium would have caused severe brain damage, likely killing her.

"There is no doubt that the surgery performed in Pakistan was life-saving," Dr. Dave Rosser, medical director of the Queen Elizabeth Hospital in Birmingham, UK, said Wednesday at a news conference.

Malala has made impressive strides and faced her medical treatment with bravery, Rosser said.

"She's very lively. She's got a great sense of humor," he said. She is aware of her high profile in the world and what that could mean for her safety.

"She remains incredibly cheerful, incredibly determined and incredibly determined to speak for her cause," Rosser said.

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With the patch of skull missing, Malala is limited in what she can do. Her brain is vulnerable to injury, if she bumps her head in the wrong way. Only her skin and soft cranial tissues stand between the outside world and her brain, and that's not enough.

Doctors could have covered the breach with the original piece of her skull, which she has carried under her skin since October, where a surgeon in Pakistan implanted it for safe keeping.

That's a common procedure to preserve bone fragments for later use, Rosser said.

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But her own skull section would have no longer fit properly without the addition of some titanium parts, as her head and the bone fragment have changed.

Titanium also has a low incidence of infection and can be handcrafted to near perfection, doctors told her.

"It was Malala's final decision," Rosser said. She picked the titanium plate.

She will also receive a cochlear implant to restore hearing to her left ear, in which she is currently deaf. The gunfire broke the delicate bones that help turn sound into sensory impulses to the brain.

The device will not allow her to hear completely naturally but will restore enough function to the damaged ear to allow her to hear in three dimensions, which is important for safety. It will allow her, for example, to hear an approaching car, Rosser said.

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Malala also recently had surgery to reroute a facial nerve that was damaged in the attempt on her life, leaving part the left side of her mouth listless.

"There is a very good chance after this procedure that within a year to 18 months, this will completely recover," Rosser said.

She will then hopefully regain her old smile.

To make the titanium plate, prosthesis maker Stefan Edmondson had the section of Malala's skull with the gap in it reproduced by an object printer.

Then he patched the hole with wax and carved it to fit the shape of her head, Edmondson said, and he used the wax section to give the titanium its form.

As for the skull fragment she has carried inside her since that emergency surgery in Pakistan:

"The bone will be removed from under the skin in her stomach and cleaned up and sterilized and given to Malala," Rosser said.

She wants to keep it as a remembrance.

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