The Democrat was targeted at a political event Saturday morning in Tucson, Ariz., by a gunman who killed six others. Doctors said at a news conference today they believe the bullet traveled from the back of her brain to the front on the left side. She escaped the more serious side-to-side path in which a bullet could cause more harm.
"The things that are most concerning to us are if the bullet crosses from one side to the other, if the bullet crosses through the geometric center of brain," said Dr. Michael Lemole, chief of neurosurgery at University Medical Center in Tucson. "I'm happy to say those were not the case in this instance.
The bullet did not travel through "some of those critical trajectories that would have made recovery much much more difficult," Lemole said.
"Because of that, Congresswoman Giffords is able to communicate with us this morning through following simple commands," he said. "We're still in critical condition. Brain swelling at any time can take a turn for the worse, but I am cautiously optimistic."
Still, Giffords' injury was severe. "It wasn't a little grazing wound," said Dr. Peter Rhee, the hospital's chief of trauma. "This is a devastating wound that traveled the entire length of the brain on the left side."
In most people, the left side of the brain controls strength and sensation on the right side of the body and the speech function. It's "the ability to make speech and understand speech and that includes the ability to understand simple commands," Lemole said.
Though the commands Giffords can follow are simple and nonverbal, like showing two fingers or squeezing a hand, they are important.
"We take those kind of simple commands for granted, but they imply a very high level of functioning in the brain," Lemole said.
"Overall this is about as good as it's going to get," Rhee said. "When you get shot in the head and the bullet goes through your brain, the chances of you living is very small and the chances of you waking up and following commands is even much smaller than that. This so far has been a very good situation. Hopefully it will stay that way."
Giffords can't speak because she's on a ventilator. Doctors turn off the sedation to conduct neurological exams.
Both doctors said it's too early to say what Giffords' long-term prognosis will be.
"We don't know what's going to happen, what her deficits will be in the future," Rhee said. "But we've been very happy with her hospital course."
During the two-hour operation, Lemole said, doctors controlled the bleeding, which was not excessive, took pressure off the brain by removing bone fragments and removed "small parts of devitalized brain."
Doctors also removed part of her skull to help relieve swelling.
Lemole said it's not uncommon for patients with Giffords' type of wound to be in the intensive care unit for at least a week, perhaps in the hospital for two to three weeks. "No doubt there will be a rehabilitive phase that could take weeks to months," Lemole said.
Experts say the severity of a brain injury depends on which part of the brain is hit but people can survive.
"When you hear someone's shot in the head, most people say, 'Forget about that one,'" Dr. Eugene Flamm, chairman of the neurosurgery department at Montefiore Medical Center in New York, told AOL News today. "On the other hand, there are examples of how you could get shot in the head and survive."
The factors to consider with a gunshot wound to the head are where the bullet struck, how much damage it caused and why surgery was needed, he said.
"The whole thing with gunshot wounds is, what part of the brain is involved," Flamm said in a telephone interview. "If it's near the top, it may not injure a part that is significant in terms of intellect.
It's also possible to get shot in the head without suffering a brain injury, or to sustain damage to a part of the brain that is not vital.
"There are parts of the brain we can remove almost with impunity," he added.
Flamm said there is a greater risk of neurological damage from a bullet that travels on a side-to-side path through the brain than from one that goes from the front to the back. That's because both sides of the brain are involved in some functions. If both sides are injured, one side can't take over for the wounded side, he said.
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"Some functions, like intellect, cognitive thinking and memory, can be controlled by both sides of the brain," he said. "If you injure both sides, it's not good."Still, a bullet that goes front-to-back could damage one side of the brain or the other. And, the side that's wounded also affects a patient's outcome.
"If the injury is on the right side, it has a much less grave prognosis," Flamm said.
But a bullet can also be devastating. If a critical part of the brain is destroyed, the function it controls, say speech or movement, is lost forever. "If it's truly destroyed, that area isn't going to come back," Flamm said. "If it's bruised, it may come back."