A baby girl whose head swelled to an  estimated three times its normal size has undergone a third skull remodelling  procedure today.

In the latest bout of surgery, Roona Begum’s  skull was painstakingly reconstructed during a four-hour operation.

Drastic draining of the fluid on her brain –  which caused her skull to balloon – had left her head severely  disfigured.

Mother’s love: Fatima Khatoon, 24 plays with her  daughter. Roona Begum, aged 18 months, suffers from hydrocephalus, a build up of  fluid inside the skullBut the third in a succession of Cranial  Vault Remodelling operations is hoped to have finally given her head a more  spherical appearance.

Dr Sandeep Vaishya, Director of Neurosurgery  at Fortis Hospital in Gurgoan, near Delhi, carried out the latest  operations.

He said: ‘This may well be the last of a  series required in the current phase.’

It is too early to tell what – if any –  surgery Roona may still need to undergo, with doctors expected to keep her in  hospital for observation for the foreseeable future.

The toddler, whose extreme case of  hydrocephalus made headlines around the world, has been making steady progress  since her admission to the private hospital, near Delhi, in mid  April.

The family were only able to travel to Delhi  and to proceed with life-saving treatment for baby Roona thanks to an online  campaign and donations from philanthropists around the world.

At the beginning of the month total costs  were estimated to have been around £36,000 and were expected to climb further as  Roona’s recovery will require close medical care.

Painstaking: It is the third skull reconstruction  operation baby Roona has undergone

The toddler’s parents, Abdul Rahman and  Fatima Khatoon, whose daily income is around £2, made an appeal for more  donations to help them cover the growing costs of Roon’as treatment and  care.

A string of procedures has drastically helped  reduce her staggering 37in head circumference.

Doctors finally declared her life was no  longer at risk at the end of May, allowing reconstructive surgery to  begin.

And while the 20-month old’s future still  remains unclear, doctors reported promising signs earlier this week.

Dr Vaishya had said: ‘Given the complexities  of the case, the prognosis is much better than expected and baby Roona is  responding well to the treatment protocol.

Prep: Baby Roona, pictured on her way into surgery in a  Delhi hospital, underwent her third successful skull reconstruction following  treatment to drain fluid form the brain

‘She is reacting to stimuli and showing signs  of cognition.’

Roona’s devoted mum Fatima, 24, said ahead of  the surgery today: ‘Roona is responding to the treatment and there are changes  in her behaviour as earlier she was playing with us.

‘I get afraid and feel sad when I look at the  scars that are there after the surgery.

‘I know it’s for her own good but as a mother  it’s difficult for me to see this little girl going through all these  operations.

‘We are looking forward to taking Roona back  home so she can start her life as a normal child.’

Roona’s poverty stricken parents from Tripura  in northern India have been touched by the generous global donations – without  which they could never have afforded their daughters vital treatment.

Father Abdul added: ‘To all those who have  helped Roona, thank you.’

Surgery: She underwent surgery last month, but her  parents – whose daily income is just £2 a day – are struggling to foot the  shortfall left by a string of complex procedures

Family: Dr. Sandeep Vaishya, left, removes the bandages  from Roona’s head

Doctors have already said that the  youngster  is lucky to be alive, with most sufferers of the condition not surviving beyond  a year old.

Director of neurosurgery Dr Vaishya, who has  personally cared for Roona,  admits there are still  challenges ahead.

He previously said: ‘We did not expect Roona  to survive this  long. We had a lot of worries initially.

‘The treatment has gone much better than  initially expected.’

The head size was reduced by about  30cm  (12ins) and has come down to around 54cm (21ins) after the first series of  treatments and operations.

Doctors hope their treatments will reduce the  head size by a further 10cm (4ins).

‘Her case has been very challenging  as we  don’t have any precedent to fall back on and nobody to guide you  at any step.  We have kept on reinventing ourselves everyday according to the situation,’ Dr  Vaishya said.

‘Now we really don’t expect much danger as  her wounds are healing and she has also started eating orally.

Roona’s improved condition has also  led her  estranged grandparents, who initially rejected the “abnormal”  child, to check  up on her health – delighting both parents.

Father Abdul Rahman said: ‘Since the medical  treatment started we have received a few calls from my parents and they do  inquire about Roona.

‘This makes me happy as earlier they  refused  to accept her as their granddaughter because of her head size –  but thanks to  every one who helped us Roona is going to have her  grandparents.

‘There is a lot of difference in her head  size than before and we are very happy about it.

‘The doctors and everyone here at the hospital have done their best to help us and I hope everything ends  soon so  that we can have our daughter back.’

Before: Abdul Rahman holds his 18-month-old daughter in  front of their home before her operation

Roona’s mother Fatima said her daughter was  responding to the treatment and showing changes in her behaviour, including  playing for the first time.

‘We are looking forward to taking Roona back  home so she can start her life as a normal child,’ she  said.

Read more: DailyMail