Giffords awake after skull surgery

HOUSTON -- Scribbled on the helmet protecting Rep. Gabrielle Giffords' injured head was a simple reminder: 5/17/11, the date doctors said she could take it off for the last time.

Now, a day after successful surgery to repair her skull, the helmet adorned with the Arizona state flag that she has worn since she was shot in the head in January is finally gone.

She is awake, communicating and doing bedside therapy. And her new look has earned her a nickname.

"I started calling her Gorgeous Gabby today," said Dr. Dong Kim, the neurosurgeon who performed the operation. "She hasn't looked in the mirror yet, but as soon as she does she'll be very pleased."

Even shaving her head to prevent infection hasn't harmed her appearance, Kim said.

"I think it looks quite cute if you ask me, and hair will grow back," he added.

Giffords' astronaut husband, Mark Kelly, is in space and couldn't see her. But he closely followed the intricate, 3 1/2-hour surgery, talking to his brother and mother-in-law by Internet phone on the International Space Station and emailing doctors.

"She's doing really, really well, as good as possibly could be expected," Kelly said in a telephone hookup from space.

Kelly said he's "looking forward" to her release from TIRR Memorial Hermann hospital in Houston, though no one, including her doctors, is saying when that will be.

Still, the operation is considered a major milestone in her recovery, and doctors said they worked according to their original plan, performing the surgery at an optimal time and not rearranging it to fit Kelly's launch schedule.

Dr. Gerard Francisco, head of Giffords' rehabilitation team at TIRR, said the surgery will also allow doctors to "upgrade" her therapy, possibly improving her rate of recovery.

Just removing the helmet will help.

Experts say it can be cumbersome during therapy. Losing the helmet can have a positive psychological impact, boosting the patient's confidence from looking healthy again.

Giffords' chief of staff Pia Carusone said "5/17/11" was scrawled on the helmet as a reminder of the last day she would have to don the headgear.

"She hates the helmet," Carusone said, noting that Giffords was excited on Tuesday, the day before the surgery. "She's been looking forward to this for a while."

A would-be assassin shot Giffords at a political event in her hometown of Tucson, Ariz. The rampage left six dead and 13 injured, including the Arizona Democrat.

After the shooting, doctors had to remove a piece of her skull to allow her brain to swell after the bullet traveled through the left side of her head. To replace the missing bone, Kim attached a piece of molded hard plastic with tiny screws. Over time, he said, her own bone will fuse with the plastic's porous material.

Giffords also had a permanent shunt placed under the skin behind her ear to drain spinal fluid from her brain and into her abdomen, Kim said. It will relieve pressure from fluids that often build up in patients with a brain injury.

The shunt is not visible and many patients forget they have one, doctors said.

Doctors said the buildup of spinal cord fluid in her brain could have created pressure on the organ, impairing some cognitive functions.

Dr. Richard Riggs, chair of physical medicine and rehabilitation at Cedars-Sinai Medical Center in Los Angeles, said relieving the pressure by draining the fluids could help her do more complex tasks and higher-level cognitive activities.

"They may have an uptick in performance afterward," he said.

In rehab, therapists try to get the patient "as independent as they can so they can be at home, so they can dress and bathe and walk around," Riggs said.

"The higher-level cognitive stuff, talking on the phone, working on the computer," Riggs said, "all those things are much more difficult."

Yet Giffords' lengthy inpatient rehabilitation -- which began in late January -- is also unusual, especially since she made two successful out-of-state trips to watch her husband's launch, an indication she can likely function at home, he said.

As expected, she had some pain and nausea shortly after Wednesday's surgery, but a scan of her brain showed the operation was successful, Kim said. She's doing so well that doctors planned to begin bedside rehabilitation therapy on Thursday.

The surgery carries a 5 to 10 percent risk of infection, Kim said, and doctors will monitor Giffords for any signs of that in the coming weeks. There are still some remaining bullet fragments in Giffords' brain that will not be removed because doing so could make her condition worse, he said.

Kim already describes Giffords' recovery to this point as "almost miraculous." They have, however, cautioned that it was still unclear what she will eventually be able to do, and it's unknown when or if she can return to work.

Francisco said that she has progressed even since late April, when TV crews filmed her from afar as she ascended the steps of a NASA plane heading for space shuttle Endeavour's launch.

While she doesn't like all aspects of her therapy, Francisco said, she cooperates once she understands the rationale behind some less enjoyable tasks and is largely in good spirits.

"She's cracked me up several times," Francisco said.

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Associated Press aerospace writer Marcia Dunn in Cape Canaveral, Fla., contributed to this report.

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Ramit Plushnick-Masti can be reached at http://twitter.com/RamitMastiAP