Malala to Receive New Titanium Skull
PHOTO: Malala Yousufzai

Malala Yousafzai, 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, Yousafzai 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 hospital where she will undergo the surgery announced today.

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.

"We're very hopeful that if you met her in two years time, there'd be no outward sign really that she'd been through what she's been through," Dr. Dave Rosser, the medical director of the Queen Elizabeth Hospital in Birmingham, told ABC News in an interview today. "It allows her to start anew."

Yousafzai 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.

"Not only does it recontour the skull, it protects the brain as well," said Dr. Stefan Edmondson, a maxillofacial prosthetist who created the titanium plate. "There's no reason it shouldn't stay there for the rest of her life."

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 .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. But Malala, her family, and the hospital decided titanium was a better choice rather than trying to reinsert a piece of bone that might carry an infection.

"The bone has been under her skin for quite some time," Rosser said. "And some of the calcium in it would have been reabsorbed. So it would be slightly smaller than it was, certainly it will be slightly thinner and less strong than it was."

The titanium plate "emulate[s] the piece of bone that's been taken away," said Edmondson.

"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.

"There are social benefits to that in terms of knowing who's talking to you in a crowded room. And there are obvious safety benefits in knowing where the car is coming from when you're crossing the road," Rosser said.

Yousafzai underwent emergency surgeries while still in Pakistan, and compared to those, her doctors in Birmingham have said these procedures will be less traumatic. They 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.

Individually, they are relatively routine. The hospital performs 50 of each procedure every year. But Rosser admitted that it's extremely rare for the hospital to perform both at the same time -- especially on someone who has undergone as much trauma as Yousafzai has.

"Certainly doing the two together in somebody who's already had a facial nerve reconstruction and the other stuff she's had done I think is pretty unique," Rosser said.

He revealed today for the first time that Yousafzai has already undergone surgery in Birmingham to repair her damaged facial nerve. Her face was no longer symmetrical and she could not close her mouth properly, Rosser told ABC News. Post-surgery, her face has at least an 80 percent chance of healing fully in the next 9-18 months.

But Rosser said Yousafzai shows no signs on long-term damage, is able to speak and read and is expected to make a full recovery.

"She's got some difficult times ahead, inevitably," he told ABC News. "But she is as I've said, very, very strong. And I have no doubt she will overcome whatever the challenges are."

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