Doctors at the University of Maryland Medical Center (UMMC) performed the world’s first surgery to remove a spinal tumor through a patient’s eye socket. The groundbreaking operation saved the life of 19-year-old Karla Flores, who had a rare and dangerous tumor wrapped around her cervical spine and spinal cord.
The tumor, known as a chordoma, is a rare type of bone cancer that grows slowly but can be deadly if not treated. Only around 300 cases are diagnosed in the United States each year. Karla’s tumor was located just below the base of her skull, a very difficult and dangerous area to reach using traditional surgery. Any mistake could have caused serious harm, including paralysis or even death.
Dr. Mohamed A.M. Labib, a neurosurgeon at UMMC and Assistant Professor of Neurosurgery at the University of Maryland School of Medicine, came up with a bold idea. Instead of opening the neck or skull, which could damage important nerves and blood vessels, he decided to use a “transorbital” approach. This means he would reach the tumor through the eye socket.
“The tumor was wrapped around the spine and spinal cord,” Dr. Labib explained. “By going through the bottom of the eye socket, we were able to remove a tumor that otherwise would have been very difficult and very risky to address.”
The surgical team included experts in neurosurgery, skull base surgery, facial plastic surgery, and radiation oncology. Dr. Kalpesh T. Vakharia, a facial plastic and reconstructive surgeon, made the careful incision inside the lower eyelid, cutting through a thin membrane called the conjunctiva.
He also made a second incision inside Karla’s mouth. Then he removed part of the eye socket and cheekbone to create a path for the surgical instruments. “We wanted to develop a surgical plan where there would be no external scars and it would be impossible to tell that the patient even had surgery,” said Dr. Vakharia.
Once the path was clear, Dr. Labib used an endoscope, a thin, lighted camera, to guide his instruments to the tumor. After removing it, Dr. Vakharia rebuilt the eye socket with a titanium plate and used bone from Karla’s hip to reconstruct the cheek.
But this was only one part of Karla’s journey. She also had another large chordoma around her brainstem, the area of the brain that controls basic life functions. To remove it, UMMC surgeons performed two more surgeries, one by opening the skull and another through the nose. These surgeries also used advanced endoscopic techniques.
Dr. Andrea M. Hebert, a head and neck surgeon at UMMC, took part in these surgeries. “These tumors are definitely life-threatening when they grow to the point where they cause significant brain stem compression, so surgery is the best way to try to save a patient’s life,” she said. “Many of these tumors come back, and that’s why we work as a team to treat them.”
After the surgeries, Karla also received proton radiation therapy to kill any remaining cancer cells. Dr. Mark Mishra, a radiation oncologist at the Maryland Proton Treatment Center, led this part of her care. To help stabilize her spine, another neurosurgeon, Dr. Timothy Chryssikos, performed a fusion surgery on the C1 and C2 vertebrae in her neck.
Today, Karla is 20 years old, cancer-free, and on the road to recovery. She still has some issues moving her left eye due to nerve damage from the tumor, but her condition is improving.
“For a while, I didn’t know what was happening to my health. It felt like no one understood or even believed that there was a physical reason for my symptoms,” Karla said. “Then I saw my ophthalmologist, who gave me hope because she believed something was wrong and referred me to Dr. Labib.”
She added, “I was so relieved when I met Dr. Labib and the team at the University of Maryland Medical Center. They listened and took me seriously. Learning about the spinal and brain tumors was terrifying, but I am so grateful the doctors were able to remove them. I’m slowly recovering, and with any problem I have, they help me.”
Karla now plans to go to school to become a manicurist. “I keep reminding myself to take one step at a time and know that each step is an accomplishment. I’m also glad I stood my ground and kept looking for help until I found it.”
Dr. Labib developed the idea for this surgery by studying cadavers in the UMMC Skull Base 360° Lab. He called the eye socket “the third nostril” in his published research and practiced the technique many times before performing it on a patient.
“The fact that people are willing to donate their bodies to science enabled us to do this and saved the life of this young woman,” Dr. Labib said.
