Surgeon: Giffords recovery 'not a miracle'

By David Brown
Washington Post Staff Writer
Friday, January 21, 2011; 10:51 AM

The extent of Rep. Gabrielle Giffords's brain damage isn't fully known, nor is her current function, but already some people are calling her recovery "miraculous."

Geoffrey T. Manley, chief of neurosurgery at San Francisco General Hospital, isn't one of them.

"This was not a miracle," Manley said Thursday, referring to reports that Giffords, who suffered a through-and-through gunshot wound to the head nearly two weeks ago, can stand, follow some directions, recognize people and make affectionate gestures.

Instead, Manley said, the Arizona Democrat's apparent good function "demonstrates what aggressive, modern trauma care can do for what we once believed were non-survivable injuries."

Survival after penetrating brain injury has increased greatly in the past 10 years, for three reasons.

The most important is more frequent use of "decompressive craniectomy," the procedure that Giffords got less than an hour after arriving at University Medical Center in Tucson. A large section of skull was removed, allowing her brain to swell unimpeded and reducing the likelihood that pressure would build up inside the skull and cause more damage.

Better post-operative intensive care - including the meticulous monitoring of pressure inside the skull - is the second reason. The third is the abandonment of some practices, such as hyperventilation of the lungs, that turned out to be more dangerous and less effective than previously thought.

These practices were developed in the civilian medical world but have been applied most widely - and perfected - in military hospitals, which have treated hundreds of soldiers with head trauma from the Iraq and Afghanistan wars.

In the past five years, 47 percent of patients with penetrating brain injury, almost all from bullets, treated at San Francisco General Hospital survived with moderate or no disability, Manley said, citing data he has recently collected for publication. Only 29 percent of all the patients died - far less than the 48 percent mortality seen in a nationwide registry of similar patients. The death rates recorded in military patients is reportedly less than 10 percent.

"There is a lot of 'therapeutic nihilism' in this country when it comes to brain injury, so it ends up being a self-fulfilling prophesy," Manley said. "What the military experience demonstrates is that aggressive care with an organized plan of treatment improves outcomes. Our civilian experience clearly reflects that, too."

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