How to survive a bullet to the brain, from Petra Anderson and Gabby Giffords to the AP reporter shot through the forehead by child soldiers

It’s “a miracle,” the doctor treating Petra Anderson recently told the press. The talented 22-year-old composer was one of the more critically injured survivors of the Aurora Batman shooting.

She was blasted in the arms and face by shotgun pellets, one pellet entered her skull and traveled through her brain in a peculiar curved path that missed all vital areas. “If the bullet had wavered a millimeter in any direction, she would have likely either died or been severely injured,” said her doctor.

As miraculous as Anderson’s story is, surviving a bullet to the brain is more common than one would think. Survival depends on the areas of the brain hit, the velocity of the bullet and several other factors, Dr. Keith Black, a Los Angeles neurosurgeon, explained to MyHealthNewsDaily. A bullet that passes through both the right and left hemispheres of the brain is more dangerous than a bullet that passes through just one. The bullet must miss structures like the brain stem and thalamus, crucial to consciousness, breathing and heartbeat as well as major blood vessels, which bring essential oxygen to the brain and the ventricles, which are filled with cerebrospinal fluid and if punctured can lead to swelling. A high-velocity bullet, like from an AK-47, does more damage than a low-velocity bullet, like from a handgun. And a bullet that exits is better than one that stays in the brain, where it can lead to swelling. To reduce the potential for swelling, people who have been shot through the brain are often put into induced comas, which gives the brain a break from work. Sometimes, pieces of the skullcap are removed too. “The brain is like Jell-O in a jar,” said Black. “If it doesn’t have any place to expand, there can be even more damage.”

Other Great Reads: The different stages of grief

The most famous case of surviving a bullet to the brain is surely that of Congresswoman Gabby Giffords. On January 8, 2011 Giffords was shot in the head outside a supermarket in a Tucson, Arizona suburb. The bullet passed through her entire skull, entering through the front and exiting through the rear, but miraculously, it never crossed the brain’s midline. Doctors performed emergency surgery to extract skull fragments and necrotic tissue. Later, ophthalmologists repaired her damaged eye socket and surgeons replaced the bone they had initially removed from her skull cap with a piece of molded hard plastic, which was set with tiny screws. Eventually, her skull is expected to fuse with the plastic’s porous material. Giffords can walk under supervision and has perfect control of her left arm and leg. She can read and speak in short phrases. Earlier this year she resigned from Congress, just before the last bill she sponsored, aimed at cracking down on cross-border drug smugglers, was brought to a vote and unanimously passed.

Ian Stewart fits all the worse bullet to the brain survival criteria, and yet somehow he survived. One fateful day in 1999, Stewart, West African bureau chief for the Associated Press, was traveling through Freetown, the capital of Sierra Leone, when his vehicle encountered a rebel checkpoint manned by a group of child soldiers. One of them unloaded his AK-47 into the backseat of the car. A colleague was shot several times in the chest and head and killed instantly, Stewart received a bullet right through the center of his forehead. It traveled down the midline of his brain and came to rest at the back of his skull. Stewart was flown to Conakry, the capitol of Guinea, then Abidjan, in the Ivory Coast, then finally London, where, nearly a day and a half after he was shot, he finally underwent surgery. Doctors gave him a 20 percent chance of survival. “I was reduced down to infancy,” said Stewart, in an interview with PBS. “I had no idea what had happened. I could not walk. I could not sit upright in the bed, couldn’t read, couldn’t write, couldn’t feed myself.” Nevertheless, a year and a half later he was almost fully functional. Stewart wrote a memoir about the experience and went back to school to pursue a doctorate on Africa’s child soldiers.

Other Great Reads: Revenge killings, from Pakistan and Palestine to Papua New Guinea

“I’m in a very good place,” said Stewart, who has since married and had children. “I’m much slower than I used to be, I don’t have the physical abilities that I used to have. But, you know, I’m happy. I found a kind of peace that I never had before.”