Five months after arriving in Portland from Iraq, 7-year-old Noora Afif Abdulhameed had surgery at Maine Medical Center on Friday to repair her damaged skull, which was partially shattered by a sniper's bullet two years ago.
In a delicate six-hour operation, Drs. James Wilson and John Atwood meticulously cut away the skin graft that Iraqi doctors had placed over Noora's brain in previous operations to save her life. Then they placed prosthetic bone, custom-made for Noora's head, over the injury.
"It went beautifully," said Wilson, a Portland pediatric neurosurgeon, after the most difficult part of the operation was over.
The surgery took longer than expected because of the difficulty of separating the scarred skin from the brain tissue without causing brain damage.
"That was my greatest fear, and that was the Iraqi doctors' greatest fear, which was well-founded," Wilson said. "But I don't think we in any way hurt her neurologic function."
Noora is expected to stay in the hospital with her father by her side until the middle or end of next week. Wilson said they may be able to return to Iraq in about a month.
Noora and her father, Afif Adbdulhameed Otaiwi, were brought to Portland in July by No More Victims, a California-based nonprofit group that brings children injured by U.S. forces in the war in Iraq to this country for treatment. The group is paying for their expenses and travel, as well as a monthly stipend for Noora's family back in Iraq.
Noora's physicians and Maine Medical Center are donating their services.
The gregarious child and her father have been living at the Ronald McDonald House in Portland's West End for the past five months while she has undergone physical exams and medical procedures in preparation for Friday's major surgery.
They spent the day before the surgery quietly, steeling themselves for what was to come the next morning.
"She's very afraid, and she's very nervous," Otaiwi said Thursday.
While grateful that his daughter was finally getting the medical help she needed, Otaiwi was worried about the final outcome, saying this was Noora's "last chance."
Noora's repaired skull will be covered with a scalp that grows hair, thanks to a procedure she had 16 weeks ago.
On Aug. 22, Atwood, a plastic surgeon, created a pocket between Noora's healthy scalp and the underlying bone, then placed an expandable balloon inside the pocket. Every few days, Noora and her father visited Atwood's office to have saline solution injected into the balloon.
By the time of Friday's surgery, the balloon had expanded to about the size of a grapefruit, stretching Noora's scalp so that doctors could use it to cover the new "bone" installed Friday.
Wilson also had to remake the leathery covering around the brain that holds spinal fluid because it was destroyed when Noora was shot. If spinal fluid comes into contact with the surgical area, it will interfere with the healing of the wound.
"We use bovine pericardium," Wilson said. "It's the sac around the heart of a calf, and we literally sew that into the existing structures there to make a water-tight barrier."
Noora was injured on Oct. 23, 2006, when she was returning home from a family celebration and a sniper began firing toward their car. The first bullet hit her father, who still has a scar from the incident. The next shot hit Noora.
Noora was rushed to the local hospital and was in a coma for 10 days. She had several operations in Iraq before coming to Maine.
Noora's father is a 42-year-old history teacher from Heet, a town of 20,000 people about 125 miles west of Baghdad. Waiting for them at home is Noora's mother, Afrah, as well as an older brother, two older sisters and a new baby sister born on Thanksgiving.